Judicial Interim Release Order Form (Page 3 of 3) in pdf

□ Report forthwith upon release to the Bail Program, 50 Eagle St. W., Newmarket and thereafter as

required or as follows

______________________________________________________________

Weapons Prohibition

□

Does not possess any firearm, cross-bow, prohibited weapon, restricted weapon, prohibited device,

ammunition, prohibited ammunition or explosive substance.

□ Does not possess or apply for any authorization, licence or registration certificate relating to the

above-named items.

□ Surrenders all above-named items and every authorization, licence and registration certificate

related thereto in his/her possession as follows: ____________________________________

__________________________________________________________________________

but assuming it would otherwise apply, s. 115 of the Criminal Code shall not apply in this order.

TAKE NOTICE that a copy of the release document entered into as a result of this order shall be sent to the

Chief Firearms Officer.

Attached is/are the Surety(ies) affidavits relating to this/these matters.

this ________of ________________200_

Dated at the Town of Newmarket in the Province of Ontario

_____________________________________

Consent of the Crown (signature)

Consent of the Crown (print name)

_____________________________________

Consent of Defence (signature)

Consent of Defence (print name)

I acknowledge that I am voluntarily agreeing to be bound by all terms and conditions of this release and

agree to pledge the amount set out.

____________________________________

_____________________________________

Surety

(signature)

Surety Name (Print)

____________________________________

______________________________________

Surety

(signature)

Surety Name (Print)

_______________________________________

_________________________________________

Accused (signature)

Accused (print name)

_____________________________________

Judge/Justice

Date

I am an interpreter accredited by the Attorney General in the language of ______________________.

and have reviewed this document with the accused ____________________________________ and

Surety _____________________________________________ and they have understood the terms and

conditions.

_________________________________________

________________________________________

Interpreter’s Signature

Interpreter (print name)

*Attach Synopsis of allegation(s) and criminal record - if any to be sealed by judicial officer.

12/02/09

Judicial Interim Release Order Form Page 3

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