HER MAJESTY THE QUEEN               V.          ____________
Plaintiff                                            Accused

Court File No. 

                                 ONTARIO COURT OF JUSTICE
                                 (Proceedings commenced) 
                                  (at ________________)


















                                  NOTICE OF APPLICATION 














                                                                 
                              For the Applicant/Accused:

                              Address:_____________________

                              _____________________________

                              Tel: ________________________