I hereby certify that I have received from X.Y., a peace officer for (territorial division), one A.B., together with a (warrant or order) issued by (set out court or justice, as the case may be).Footnote *
Return to footnote *Add a statement of the condition of the prisoner
Dated this day of A.D. , at .
Keeper of (prison)
- R.S., 1985, c. C-46, Form 43;
- 1995, c. 22, s. 18.
- Date modified: