Rules of the Supreme Court of Canada

TAKE NOTICE that, pursuant to leave granted by the Court on (date), (name of appellant) appeals to the Supreme Court of Canada from the judgment of the (name of the court appealed from) made on (date);

OR

TAKE NOTICE that (name) appeals as of right to the Supreme Court of Canada from the judgment of the (name of the court appealed from) made on (date) under (set out the provision(s) of the statute that authorizes the appeal);

(In the case of an appeal under paragraph 691(1)(a) or (2)(a) or (b), 692(3)(a) or 693(1)(a) of the Criminal Code, state the following:)

AND FURTHER TAKE NOTICE that this appeal raises the following question or questions of law:

AND/OR

AND FURTHER TAKE NOTICE that the dissenting judgment of the court appealed from is, in whole or in part, based on the following questions of law: (as specified in the judgment issued under section 677 of the Criminal Code).

Dated at (place), (province or territory) this (date) day of (month), (year).

SIGNED BY (signature of counsel or party or agent)

Appellant (Counsel’s (or party’s, if unrepresented) name, address and telephone number, and fax number and email address (if any))

Agent (Agent’s name, address and telephone number, and fax number and email address (if any))

ORIGINAL TO: THE REGISTRAR

COPIES TO: (Name, address and telephone number, and fax number and email address (if any), of every party and all other parties and interveners in the court appealed from)

(In the case of an appeal as of right, include a copy of the judgment and reasons for judgment of the court appealed from and a copy of the certificate in Form 23A and, if applicable, a copy of the certificates in Forms 23B or 23C.)