Type of Conviction (Summary or Indictable or Finding of Dangerous Offender or Long-Term Offender
In Custody
Note in Custody
Person Making Application on Applicant's Behalf (if any)
Telephone Number
SECTION B - SUPPORTING INFORMATION
Date of Preliminary Inquiry
Date of Other Pre-Trial Motions (eg. Bail Hearing, Charter Application, etc.)
Particulars Relating to Motion
Plea:
Guilty
Not Guilty
Names and Addresses of Counsel
Particulars Relating to Motion
Grounds for Application

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Description of the New Matters of Significance that Support this Application

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SECTION C - REQUIRED DOCUMENTS (Mandatory)
Applicant's Consent to the Release of Personal Information
PRE-TRIAL
(if unable to provide any of the following, please explain why)
(Affidavits, letters, photographs, plans, drawings, technical and scientific reports, etc.)