Information No.

ONTARIO COURT OF JUSTICE

((specify) Region)

BETWEEN:

(indicate whether applicant or respondent)

and

(specify name of accused)

(indicate whether applicant or respondent)

REQUISITION

(Rules of the Ontario Court of Justice in Criminal Proceedings, Rule 4.09, Form 15)

TO THE CLERK AT (place)

I REQUIRE (Set out a concise statement of what is sought and include all particulars necessary for the clerk to act. Where what is sought is authorized by an order, refer to the order in the requisition and attach a copy of the entered order. Where an affidavit or other document must be filed with the requisition, refer to it in the requisition and attach it.)

Dated at , , this day of , (year).