Court of Queen’s Bench for Alberta Summary Conviction Appeal Rules (SI/2012-39)

Regulations are current to 2017-11-20 and last amended on 2012-07-01. Previous Versions

Form A(Rule 2)

COURT FILE NUMBERClerk’s stamp:
COURT OF QUEEN’S BENCH OF ALBERTA
JUDICIAL CENTRE
APPELLANT/RESPONDENTHER MAJESTY THE QUEEN
RESPONDENT/APPELLANT
DOCUMENTNotice of Appeal
ADDRESS FOR SERVICE AND
CONTACT INFORMATION OF
PARTY FILING THIS DOCUMENT
The Appeal will be heard before a Justice of the Court of Queen’s Bench:
Date
Time
Where

The Rules of this Court require an appellant to deliver to the Court a transcript of the proceedings before the summary conviction court, a list of authorities and a memorandum of argument at least 30 days prior to the above-mentioned date of the hearing.

  • 1 
    TAKE NOTICE that the Appellant wishes to appeal and does hereby appeal to the Court of Queen’s Bench of Alberta, sitting at

    , in the Province of Alberta, from the decision of the Provincial Court of Alberta set out below.

  • 2 
    The full name of the Appellant, if not Her Majesty the Queen, is: (Print name and date of birth)

    (Name):

    (Date of Birth):

  • 3 
    The decision of the Provincial Court being appealed from is a:
    •  
      Conviction Only
    •  
      Sentence Only
    •  
      Conviction and Sentence
    •  
      Dismissal
    •  
      Order

    and the particulars of the decision are as follows:

    • (a) 
      Date of Decision:
    • (b) 
      Place of Decision:
    • (c) 
      Name of Judge or Commissioner:
    • (d) 
      Name of Prosecutor, If Known:
    • (e) 
      Name of Defence Counsel, If Known:
    • (f) 
      Plea at Trial (if applicable): Guilty Not Guilty

    If no Trial: Convicted in Absence Voluntary Payment

    • (g) 
      Nature of Offence(s) charged:
    • (h) 
      Sentence or Order (if applicable):
    • (i) 
      If driving offence(s) charged, Driver’s License Number of Appellant is:
    • (j) 
      If the Appellant (or Respondent if applicable) is in custody,

      Place of Custody:

  • 4 
    The grounds of appeal of the Appellant are as follows:

  • 5 
    The Appellant seeks the following relief or remedy:

  • 6 
    This Notice of Appeal is dated this day of 2
Appellant/Appellant’s counsel
 
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