Court File No. _________


                   COURT OF APPEAL FOR ONTARIO 

Between:
                   ___________________________

                                                Appellant-Accused
                               and 

                      Her Majesty the Queen

                                             Respondent/Plaintiff



           -------------------------------------------
           RECORD OF APPLICATION FOR EXTENSION OF TIME 
           -------------------------------------------




                              Index

1. Notice of Application for Extension of Time to Appeal 

2. Appellant's Affidavit 

3. Notice of Appeal 




For the Applicant/Accused: 

Name: ___________________________________ 

Address: ________________________________________________ 

Tel: _________________________  Fax: _____________________ 

Email: ___________________________________



For the Respondent: 

Attorney General for Canada

Address: _________________________________________________

Tel: _________________________  Fax: _____________________ 

or Suite 3400 - 130 King St. W. Toronto Ontario M5X 1K6

Tel: 416-973-0392 Fax: 952-2116