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C-25.1, r. 1 - Regulation respecting the form of statements of offence
Schedule
Disposition versions
SCHEDULE IV
(s. 23, 1st par., subpar. 4)
STATEMENT OF OFFENCE
Penal proceedings are instituted by means of a statement of offence and commence on the date of service of the statement of offence.
PLEA
You are required to enter a plea of guilty or not guilty within 30 days after the date of service indicated in the “SERVICE” section of the statement of offence.
If the defendant is a legal person, one of its directors or officers is required to sign. “Director” means the president, chief executive officer, chief operating officer, chief financial officer or secretary of the legal person or a person holding a similar position that legal person. The signatory must indicate his quality.
PLEA OF GUILTY AND PAYMENT
If you plead guilty to the offence charged, please use the attached plea form to:
- enter your plea, and
- pay (in Canadian funds) the total amount of the fine, costs and contribution indicated on the statement of offence.
In accordance with section 8.1 of the Code of Penal Procedure (chapter C-25.1), from each contribution collected, the first $10 shall be credited to the fund dedicated to assistance for persons who are victims of criminal offences established under the Act to assist persons who are victims of criminal offences and to facilitate their recovery (chapter P-9.2.1), and the following $8 shall be credited to the Access to Justice Fund established under the Act respecting the Ministère de la Justice (chapter M-19).
The plea and the payment may be send to the address indicated on the plea form or ..........
Payment may be made (indicate method of payment).
A defendant who enters a plea of guilty is deemed to have been convicted of the offence.
Additional costs may be imposed if the total amount of the fine, costs and contribution is not transmitted with the plea of guilty.
A defendant who transmits the total amount of the fine and costs requested after having entered a plea of not guilty and before the trial is deemed to have transmitted a plea of guilty.
A defendant who transmits the whole amount of the fine and costs requested without entering a plea is deemed to have transmitted a plea of guilty.
PLEA OF NOT GUILTY
If you plead not guilty to the offence, please enter your plea on the back of the attached plea form. Your plea must be sent to the address indicate on the plea form.
You will be notified by the clerk of the competent court of the place, date and time set for the trial.
PRELIMINARY APPLICATIONS
To prepare your defence, you may file a preliminary application as provided in articles 168 to 186 of the Code of Penal Procedure.
FAILURE TO ENTER A PLEA AND PAY THE TOTAL AMOUNT OF THE FINE AND COSTS
| WARNING NO. 1 |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OR A PART OF THE FINE AND COSTS WITHIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” SECTION OF THE STATEMENT OF OFFENCE, YOU WILL BE DEEMED NOT TO CONTEST THE PROCEEDINGS AND MAY BE CONVICTED BY DEFAULT (IN YOUR ABSENCE) WITHOUT AN OPPORTUNITY TO BE HEARD. |
| WARNING NO. 2 |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OF THE FINE AND COSTS WITHIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” SECTION OF THE STATEMENT OF OFFENCE OR IN THE DOCUMENT REFERRED TO, YOU WILL BE DEEMED TO HAVE ENTERED A PLEA OF NOT GUILTY. PROCEEDINGS WILL THEN BE TRIED IN YOUR ABSENCE AND JUDGMENT WILL BE RENDERED WITHOUT FURTHER NOTICE. |
IF YOU ARE CONVICTED BY DEFAULT, ADDITIONAL COSTS MAY BE IMPOSED..
RIGHT TO LEGAL COUNSEL
You have the right to seek legal counsel before entering a plea or making a preliminary application.
| INFORMATION |
| PROSECUTOR’S ADDRESS (IF APPLICABLE) |
DEFENDANT
SCHEDULE IV
(s. 23, 1st par., subpar. 4)
STATEMENT OF OFFENCE
Penal proceedings are instituted by means of a statement of offence and commence on the date of service of the statement of offence.
PLEA
You are required to enter a plea of guilty or not guilty within 30 days after the date of service indicated in the “SERVICE” section of the statement of offence.
If the defendant is a legal person, one of its directors or officers is required to sign. “Director” means the president, chief executive officer, chief operating officer, chief financial officer or secretary of the legal person or a person holding a similar position that legal person. The signatory must indicate his quality.
PLEA OF GUILTY AND PAYMENT
If you plead guilty to the offence charged, please use the attached plea form to:
- enter your plea, and
- pay (in Canadian funds) the total amount of the fine, costs and contribution indicated on the statement of offence.
In accordance with section 8.1 of the Code of Penal Procedure (chapter C-25.1), from each contribution collected, the first $10 shall be credited to the Crime Victims Assistance Fund established under the Act respecting assistance for victims of crime (chapter A-13.2), and the following $8 shall be credited to the Access to Justice Fund established under the Act respecting the Ministère de la Justice (chapter M-19).
The plea and the payment may be send to the address indicated on the plea form or ..........
Payment may be made (indicate method of payment).
A defendant who enters a plea of guilty is deemed to have been convicted of the offence.
Additional costs may be imposed if the total amount of the fine, costs and contribution is not transmitted with the plea of guilty.
A defendant who transmits the total amount of the fine and costs requested after having entered a plea of not guilty and before the trial is deemed to have transmitted a plea of guilty.
A defendant who transmits the whole amount of the fine and costs requested without entering a plea is deemed to have transmitted a plea of guilty.
PLEA OF NOT GUILTY
If you plead not guilty to the offence, please enter your plea on the back of the attached plea form. Your plea must be sent to the address indicate on the plea form.
You will be notified by the clerk of the competent court of the place, date and time set for the trial.
PRELIMINARY APPLICATIONS
To prepare your defence, you may file a preliminary application as provided in articles 168 to 186 of the Code of Penal Procedure.
FAILURE TO ENTER A PLEA AND PAY THE TOTAL AMOUNT OF THE FINE AND COSTS
| WARNING NO. 1 |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OR A PART OF THE FINE AND COSTS WITHIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” SECTION OF THE STATEMENT OF OFFENCE, YOU WILL BE DEEMED NOT TO CONTEST THE PROCEEDINGS AND MAY BE CONVICTED BY DEFAULT (IN YOUR ABSENCE) WITHOUT AN OPPORTUNITY TO BE HEARD. |
| WARNING NO. 2 |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OF THE FINE AND COSTS WITHIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” SECTION OF THE STATEMENT OF OFFENCE OR IN THE DOCUMENT REFERRED TO, YOU WILL BE DEEMED TO HAVE ENTERED A PLEA OF NOT GUILTY. PROCEEDINGS WILL THEN BE TRIED IN YOUR ABSENCE AND JUDGMENT WILL BE RENDERED WITHOUT FURTHER NOTICE. |
IF YOU ARE CONVICTED BY DEFAULT, ADDITIONAL COSTS MAY BE IMPOSED..
RIGHT TO LEGAL COUNSEL
You have the right to seek legal counsel before entering a plea or making a preliminary application.
| INFORMATION |
| PROSECUTOR’S ADDRESS (IF APPLICABLE) |
DEFENDANT
SCHEDULE IV
(s. 23, 1st par., subpar. 4)
STATEMENT OF OFFENCE
Penal proceedings are instituted by means of a statement of offence and commence on the date of service of the statement of offence.
PLEA
You are required to enter a plea of guilty or not guilty within 30 days after the date of service indicated in the “SERVICE” section of the statement of offence.
If the defendant is a legal person, a director or officer of the defendant must sign the plea and indicate his or her capacity.
PLEA OF GUILTY AND PAYMENT
If you plead guilty to the offence charged, please use the attached plea form to:
- enter your plea, and
- pay (in Canadian funds) the total amount of the fine, costs and contribution indicated on the statement of offence.
In accordance with section 8.1 of the Code of Penal Procedure (chapter C-25.1), from each contribution collected, the first $10 shall be credited to the Crime Victims Assistance Fund established under the Act respecting assistance for victims of crime (chapter A-13.2), and the following $8 shall be credited to the Access to Justice Fund established under the Act respecting the Ministère de la Justice (chapter M-19).
The plea and the payment may be send to the address indicated on the plea form or ..........
Payment may be made (indicate method of payment).
A defendant who enters a plea of guilty is deemed to have been convicted of the offence.
Additional costs may be imposed if the total amount of the fine, costs and contribution is not transmitted with the plea of guilty.
A defendant who transmits the total amount of the fine and costs requested after having entered a plea of not guilty and before the trial is deemed to have transmitted a plea of guilty.
PLEA OF NOT GUILTY
If you plead not guilty to the offence, please enter your plea on the back of the attached plea form. Your plea must be sent to the address indicate on the plea form.
You will be notified by the clerk of the competent court of the place, date and time set for the trial.
PRELIMINARY APPLICATIONS
To prepare your defence, you may file with your plea of not guilty a preliminary application as provided in articles 168 to 186 of the Code of Penal Procedure.
FAILURE TO ENTER A PLEA AND PAY THE TOTAL AMOUNT OF THE FINE AND COSTS
__________________________________________________________________________________
| |
| WARNING NO. 1 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OR A PART OF THE FINE |
| AND COSTS WITNIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” |
| SECTION OF THE STATEMENT OF OFFENCE, YOU WILL BE DEEMED NOT TO CONTEST THE |
| PROCEEDINGS AND MAY BE CONVICTED BY DEFAULT (IN YOUR ABSENCE) WITHOUT AN |
| OPPORTUNITY TO BE HEARD. |
|__________________________________________________________________________________|
__________________________________________________________________________________
| |
| WARNING NO. 2 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OF THE FINE AND COSTS |
| WITHIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” SECTION OF |
| THE STATEMENT OF OFFENCE OR IN THE DOCUMENT REFERRED TO, YOU WILL BE DEEMED TO |
| HAVE ENTERED A PLEA OF NOT GUILTY. PROCEEDINGS WILL THEN BE TRIED IN YOUR |
| ABSENCE AND JUDGMENT WILL BE RENDERED WITHOUT FURTHER NOTICE. |
|__________________________________________________________________________________|
| |
| WARNING NO. 1 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OR A PART OF THE FINE |
| AND COSTS WITNIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” |
| SECTION OF THE STATEMENT OF OFFENCE, YOU WILL BE DEEMED NOT TO CONTEST THE |
| PROCEEDINGS AND MAY BE CONVICTED BY DEFAULT (IN YOUR ABSENCE) WITHOUT AN |
| OPPORTUNITY TO BE HEARD. |
|__________________________________________________________________________________|
__________________________________________________________________________________
| |
| WARNING NO. 2 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OF THE FINE AND COSTS |
| WITHIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” SECTION OF |
| THE STATEMENT OF OFFENCE OR IN THE DOCUMENT REFERRED TO, YOU WILL BE DEEMED TO |
| HAVE ENTERED A PLEA OF NOT GUILTY. PROCEEDINGS WILL THEN BE TRIED IN YOUR |
| ABSENCE AND JUDGMENT WILL BE RENDERED WITHOUT FURTHER NOTICE. |
|__________________________________________________________________________________|
IF YOU ARE CONVICTED BY DEFAULT, ADDITIONAL COSTS MAY BE IMPOSED..
RIGHT TO LEGAL COUNSEL
You have the right to seek legal counsel before entering a plea or making a preliminary application.
__________________________________________________________________________________
| |
| INFORMATION |
| |
| |
| |
| PROSECUTOR’S ADDRESS (IF APPLICABLE) |
|__________________________________________________________________________________|
| |
| INFORMATION |
| |
| |
| |
| PROSECUTOR’S ADDRESS (IF APPLICABLE) |
|__________________________________________________________________________________|
DEFENDANT
SCHEDULE IV
(s. 23, 1st par., subpar. 4)
000000 0000000000
CANADA
PROVINCE OF QUÉBEC
STATEMENT OF OFFENCE
(PARKING)
Judicial district
Prosecutor
Vehicle owner
Defendant
PAYMENT: SEE PLEA
FORM
VEHICLE
Licence plate number Prov/State Vehicle make Model
Temporary registration certificate Towing/Vehicle towed to
Surname Given name
Address Apt.
Town/City Province/State Postal code
Time of the offence Date of offence (Y-M-D)
From To
PLACE
District Parking sign Parking meter number
Location
Highway/Road Direction Location Unit
1- Facing
2- Near
3- Opposite
4- Inters.
5- Rear
Side
1- North
2- South
3- East
4- West
DESCRIPTION OF THE OFFENCE
$
PENALTY
Minimum fine Costs Contribution Total amount
$ + $ + $ = $
c If this box is checked, towing fees of $ __________________have been added.
ATTESTATION/SERVICE
ATTESTATION
I, the undersigned, certify that I personally witnessed the facts set out in this statement of offence and have reasonable grounds to believe that the above-described offence has been committed.
Name (in block letters)
Person entrusted with the enforcement of the Act Capacity
c I did not deliver the duplicate of the statement
c I witnessed the facts and served the duplicate of the statement (only one signature required)
Signature
SERVICE
I certify that I delivered a duplicate of the statement of offence
c at the time of the offence
c subsequent to the commission of the offence
c by leaving it in a conspicuous place on the vehicle
c in another manner (specify):
Name (in block letters) c same as attestation
Person entrusted with the enforcement of the Act Capacity
Date of service (Y-M-D) Time (H-M)
Signature
IMPORTANT
PLEASE READ WARGNING NO. 1 ON THE BACK.
HOWEVER, IF YOU ARE UNDER 18 YEARS OF AGE OR IF THIS BOX IS CHECKED c
PLEASE READ WARNING NO. 2 ON THE BACK.
DEFENDANT
CANADA
PROVINCE OF QUÉBEC
STATEMENT OF OFFENCE
(PARKING)
Judicial district
Prosecutor
Vehicle owner
Defendant
PAYMENT: SEE PLEA
FORM
VEHICLE
Licence plate number Prov/State Vehicle make Model
Temporary registration certificate Towing/Vehicle towed to
Surname Given name
Address Apt.
Town/City Province/State Postal code
Time of the offence Date of offence (Y-M-D)
From To
PLACE
District Parking sign Parking meter number
Location
Highway/Road Direction Location Unit
1- Facing
2- Near
3- Opposite
4- Inters.
5- Rear
Side
1- North
2- South
3- East
4- West
DESCRIPTION OF THE OFFENCE
$
PENALTY
Minimum fine Costs Contribution Total amount
$ + $ + $ = $
c If this box is checked, towing fees of $ __________________have been added.
ATTESTATION/SERVICE
ATTESTATION
I, the undersigned, certify that I personally witnessed the facts set out in this statement of offence and have reasonable grounds to believe that the above-described offence has been committed.
Name (in block letters)
Person entrusted with the enforcement of the Act Capacity
c I did not deliver the duplicate of the statement
c I witnessed the facts and served the duplicate of the statement (only one signature required)
Signature
SERVICE
I certify that I delivered a duplicate of the statement of offence
c at the time of the offence
c subsequent to the commission of the offence
c by leaving it in a conspicuous place on the vehicle
c in another manner (specify):
Name (in block letters) c same as attestation
Person entrusted with the enforcement of the Act Capacity
Date of service (Y-M-D) Time (H-M)
Signature
IMPORTANT
PLEASE READ WARGNING NO. 1 ON THE BACK.
HOWEVER, IF YOU ARE UNDER 18 YEARS OF AGE OR IF THIS BOX IS CHECKED c
PLEASE READ WARNING NO. 2 ON THE BACK.
DEFENDANT
STATEMENT OF OFFENCE
Penal proceedings are instituted by means of a statement of offence and commence on the date of service of the statement of offence.
PLEA
You are required to enter a plea of guilty or not guilty within 30 days after the date of service indicated in the “SERVICE” section of the statement of offence.
If the defendant is a legal person, a director or officer of the defendant must sign the plea and indicate his or her capacity.
PLEA OF GUILTY AND PAYMENT
If you plead guilty to the offence charged, please use the attached plea form to:
- enter your plea, and
- pay (in Canadian funds) the total amount of the fine, costs and contribution indicated on the statement of offence.
In accordance with section 8.1 of the Code of Penal Procedure (chapter C-25.1), from each contribution collected, the first $10 shall be credited to the Crime Victims Assistance Fund established under the Act respecting assistance for victims of crime (chapter A-13.2), and the following $8 shall be credited to the Access to Justice Fund established under the Act respecting the Ministère de la Justice (chapter M-19).
The plea and the payment may be send to the address indicated on the plea form or ..........
Payment may be made (indicate method of payment).
A defendant who enters a plea of guilty is deemed to have been convicted of the offence.
Additional costs may be imposed if the total amount of the fine, costs and contribution is not transmitted with the plea of guilty.
PLEA OF NOT GUILTY
If you plead not guilty to the offence, please enter your plea on the back of the attached plea form. Your plea must be sent to the address indicate on the plea form.
You will be notified by the clerk of the competent court of the place, date and time set for the trial.
PRELIMINARY APPLICATIONS
To prepare your defence, you may file with your plea of not guilty a preliminary application as provided in articles 168 to 186 of the Code of Penal Procedure.
FAILURE TO ENTER A PLEA AND PAY THE TOTAL AMOUNT OF THE FINE AND COSTS
__________________________________________________________________________________
| |
| WARNING NO. 1 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OR A PART OF THE FINE |
| AND COSTS WITNIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” |
| SECTION OF THE STATEMENT OF OFFENCE, YOU WILL BE DEEMED NOT TO CONTEST THE |
| PROCEEDINGS AND MAY BE CONVICTED BY DEFAULT (IN YOUR ABSENCE) WITHOUT AN |
| OPPORTUNITY TO BE HEARD. |
|__________________________________________________________________________________|
__________________________________________________________________________________
| |
| WARNING NO. 2 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OF THE FINE AND COSTS |
| WITHIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” SECTION OF |
| THE STATEMENT OF OFFENCE OR IN THE DOCUMENT REFERRED TO, YOU WILL BE DEEMED TO |
| HAVE ENTERED A PLEA OF NOT GUILTY. PROCEEDINGS WILL THEN BE TRIED IN YOUR |
| ABSENCE AND JUDGMENT WILL BE RENDERED WITHOUT FURTHER NOTICE. |
|__________________________________________________________________________________|
| |
| WARNING NO. 1 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OR A PART OF THE FINE |
| AND COSTS WITNIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” |
| SECTION OF THE STATEMENT OF OFFENCE, YOU WILL BE DEEMED NOT TO CONTEST THE |
| PROCEEDINGS AND MAY BE CONVICTED BY DEFAULT (IN YOUR ABSENCE) WITHOUT AN |
| OPPORTUNITY TO BE HEARD. |
|__________________________________________________________________________________|
__________________________________________________________________________________
| |
| WARNING NO. 2 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OF THE FINE AND COSTS |
| WITHIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” SECTION OF |
| THE STATEMENT OF OFFENCE OR IN THE DOCUMENT REFERRED TO, YOU WILL BE DEEMED TO |
| HAVE ENTERED A PLEA OF NOT GUILTY. PROCEEDINGS WILL THEN BE TRIED IN YOUR |
| ABSENCE AND JUDGMENT WILL BE RENDERED WITHOUT FURTHER NOTICE. |
|__________________________________________________________________________________|
IF YOU ARE CONVICTED BY DEFAULT, ADDITIONAL COSTS MAY BE IMPOSED..
RIGHT TO LEGAL COUNSEL
You have the right to seek legal counsel before entering a plea or making a preliminary application.
__________________________________________________________________________________
| |
| INFORMATION |
| |
| |
| |
| PROSECUTOR’S ADDRESS (IF APPLICABLE) |
|__________________________________________________________________________________|
| |
| INFORMATION |
| |
| |
| |
| PROSECUTOR’S ADDRESS (IF APPLICABLE) |
|__________________________________________________________________________________|
DEFENDANT
CANADA
PROVINCE OF QUÉBEC
PLEA FORM
Judicial district
Licence plate number Province/State Vehicle make Model
Date of offence (Y-M-D)
PLEA OF GUILTY
c I plead guilty Signature:
Capacity (title) Date
PAYMENT
If you plead guilty to the offence charged, you must pay the Total Amount indicated, or your may be required to pay and additional amount as costs.
Your plea and your payment must be sent no later than 30 days after the date of service appearing at the bottom of this form or, if service was made by mail, the date on the notice of receipt or delivery or on the envelope.
Your plea and payment must be sent to:
RETURN THIS FORM WITH YOUR PAYMENT
$
PENALTY
Minimum fine Costs Contribution Total amount
$ + $ + $ = $
c If this box is checked, towing fees of $ __________________have been added.
AMOUT PAID
$
Date of service (Y-M-D) Time (H-M)
PLEA OF NOT GUILTY
To enter a plea of not guilty, you must complete this form.
c I plead not guilty Signature:
Surname (in block letters) Given name
No. and street Apt.
Town/City
Province Postal code Date (Y-M-D)
Licence plate number Province/State Vehicle make Model
If this statement of offence is maintained, you will be notified by the clerk of the competent courts of the place, date and time set for the trial of the proceedings.
This plea of not guilty must be sent to the following address, no later than 30 days after the date of service:
Address where plea form must be sent
CASHIER’S STAMP
PROVINCE OF QUÉBEC
PLEA FORM
Judicial district
Licence plate number Province/State Vehicle make Model
Date of offence (Y-M-D)
PLEA OF GUILTY
c I plead guilty Signature:
Capacity (title) Date
PAYMENT
If you plead guilty to the offence charged, you must pay the Total Amount indicated, or your may be required to pay and additional amount as costs.
Your plea and your payment must be sent no later than 30 days after the date of service appearing at the bottom of this form or, if service was made by mail, the date on the notice of receipt or delivery or on the envelope.
Your plea and payment must be sent to:
RETURN THIS FORM WITH YOUR PAYMENT
$
PENALTY
Minimum fine Costs Contribution Total amount
$ + $ + $ = $
c If this box is checked, towing fees of $ __________________have been added.
AMOUT PAID
$
Date of service (Y-M-D) Time (H-M)
PLEA OF NOT GUILTY
To enter a plea of not guilty, you must complete this form.
c I plead not guilty Signature:
Surname (in block letters) Given name
No. and street Apt.
Town/City
Province Postal code Date (Y-M-D)
Licence plate number Province/State Vehicle make Model
If this statement of offence is maintained, you will be notified by the clerk of the competent courts of the place, date and time set for the trial of the proceedings.
This plea of not guilty must be sent to the following address, no later than 30 days after the date of service:
Address where plea form must be sent
CASHIER’S STAMP
SCHEDULE IV
(s. 23, 1st par., subpar. 4)
000000 0000000000
CANADA
PROVINCE OF QUÉBEC
STATEMENT OF OFFENCE
(PARKING)
Judicial district
Prosecutor
Vehicle owner
Defendant
PAYMENT: SEE PLEA
FORM
VEHICLE
Licence plate number Prov/State Vehicle make Model
Temporary registration certificate Towing/Vehicle towed to
Surname Given name
Address Apt.
Town/City Province/State Postal code
Time of the offence Date of offence (Y-M-D)
From To
PLACE
District Parking sign Parking meter number
Location
Highway/Road Direction Location Unit
1- Facing
2- Near
3- Opposite
4- Inters.
5- Rear
Side
1- North
2- South
3- East
4- West
DESCRIPTION OF THE OFFENCE
$
PENALTY
Minimum fine Costs Contribution Total amount
$ + $ + $ = $
c If this box is checked, towing fees of $ __________________have been added.
ATTESTATION/SERVICE
ATTESTATION
I, the undersigned, certify that I personally witnessed the facts set out in this statement of offence and have reasonable grounds to believe that the above-described offence has been committed.
Name (in block letters)
Person entrusted with the enforcement of the Act Capacity
c I did not deliver the duplicate of the statement
c I witnessed the facts and served the duplicate of the statement (only one signature required)
Signature
SERVICE
I certify that I delivered a duplicate of the statement of offence
c at the time of the offence
c subsequent to the commission of the offence
c by leaving it in a conspicuous place on the vehicle
c in another manner (specify):
Name (in block letters) c same as attestation
Person entrusted with the enforcement of the Act Capacity
Date of service (Y-M-D) Time (H-M)
Signature
IMPORTANT
PLEASE READ WARGNING NO. 1 ON THE BACK.
HOWEVER, IF YOU ARE UNDER 18 YEARS OF AGE OR IF THIS BOX IS CHECKED c
PLEASE READ WARNING NO. 2 ON THE BACK.
DEFENDANT
CANADA
PROVINCE OF QUÉBEC
STATEMENT OF OFFENCE
(PARKING)
Judicial district
Prosecutor
Vehicle owner
Defendant
PAYMENT: SEE PLEA
FORM
VEHICLE
Licence plate number Prov/State Vehicle make Model
Temporary registration certificate Towing/Vehicle towed to
Surname Given name
Address Apt.
Town/City Province/State Postal code
Time of the offence Date of offence (Y-M-D)
From To
PLACE
District Parking sign Parking meter number
Location
Highway/Road Direction Location Unit
1- Facing
2- Near
3- Opposite
4- Inters.
5- Rear
Side
1- North
2- South
3- East
4- West
DESCRIPTION OF THE OFFENCE
$
PENALTY
Minimum fine Costs Contribution Total amount
$ + $ + $ = $
c If this box is checked, towing fees of $ __________________have been added.
ATTESTATION/SERVICE
ATTESTATION
I, the undersigned, certify that I personally witnessed the facts set out in this statement of offence and have reasonable grounds to believe that the above-described offence has been committed.
Name (in block letters)
Person entrusted with the enforcement of the Act Capacity
c I did not deliver the duplicate of the statement
c I witnessed the facts and served the duplicate of the statement (only one signature required)
Signature
SERVICE
I certify that I delivered a duplicate of the statement of offence
c at the time of the offence
c subsequent to the commission of the offence
c by leaving it in a conspicuous place on the vehicle
c in another manner (specify):
Name (in block letters) c same as attestation
Person entrusted with the enforcement of the Act Capacity
Date of service (Y-M-D) Time (H-M)
Signature
IMPORTANT
PLEASE READ WARGNING NO. 1 ON THE BACK.
HOWEVER, IF YOU ARE UNDER 18 YEARS OF AGE OR IF THIS BOX IS CHECKED c
PLEASE READ WARNING NO. 2 ON THE BACK.
DEFENDANT
STATEMENT OF OFFENCE
Penal proceedings are instituted by means of a statement of offence and commence on the date of service of the statement of offence.
PLEA
You are required to enter a plea of guilty or not guilty within 30 days after the date of service indicated in the “SERVICE” section of the statement of offence.
If the defendant is a legal person, a director or officer of the defendant must sign the plea and indicate his or her capacity.
PLEA OF GUILTY AND PAYMENT
If you plead guilty to the offence charged, please use the attached plea form to:
- enter your plea, and
- pay (in Canadian funds) the total amount of the fine, costs and contribution indicated on the statement of offence.
The amount of the contribution provided for in article 8.1 of the Code of Penal Procedure (chapter C-25.1) is, in a proportion of 10/14, used to provide assistance to victims of crime and, in a proportion of 4/14, credited to the Access to Justice Fund established under the Act respecting the Ministère de la Justice (chapter M-19).
The plea and the payment may be send to the address indicated on the plea form or ..........
Payment may be made (indicate method of payment).
A defendant who enters a plea of guilty is deemed to have been convicted of the offence.
Additional costs may be imposed if the total amount of the fine, costs and contribution is not transmitted with the plea of guilty.
PLEA OF NOT GUILTY
If you plead not guilty to the offence, please enter your plea on the back of the attached plea form. Your plea must be sent to the address indicate on the plea form.
You will be notified by the clerk of the competent court of the place, date and time set for the trial.
PRELIMINARY APPLICATIONS
To prepare your defence, you may file with your plea of not guilty a preliminary application as provided in articles 168 to 186 of the Code of Penal Procedure.
FAILURE TO ENTER A PLEA AND PAY THE TOTAL AMOUNT OF THE FINE AND COSTS
__________________________________________________________________________________
| |
| WARNING NO. 1 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OR A PART OF THE FINE |
| AND COSTS WITNIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” |
| SECTION OF THE STATEMENT OF OFFENCE, YOU WILL BE DEEMED NOT TO CONTEST THE |
| PROCEEDINGS AND MAY BE CONVICTED BY DEFAULT (IN YOUR ABSENCE) WITHOUT AN |
| OPPORTUNITY TO BE HEARD. |
|__________________________________________________________________________________|
__________________________________________________________________________________
| |
| WARNING NO. 2 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OF THE FINE AND COSTS |
| WITHIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” SECTION OF |
| THE STATEMENT OF OFFENCE OR IN THE DOCUMENT REFERRED TO, YOU WILL BE DEEMED TO |
| HAVE ENTERED A PLEA OF NOT GUILTY. PROCEEDINGS WILL THEN BE TRIED IN YOUR |
| ABSENCE AND JUDGMENT WILL BE RENDERED WITHOUT FURTHER NOTICE. |
|__________________________________________________________________________________|
| |
| WARNING NO. 1 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OR A PART OF THE FINE |
| AND COSTS WITNIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” |
| SECTION OF THE STATEMENT OF OFFENCE, YOU WILL BE DEEMED NOT TO CONTEST THE |
| PROCEEDINGS AND MAY BE CONVICTED BY DEFAULT (IN YOUR ABSENCE) WITHOUT AN |
| OPPORTUNITY TO BE HEARD. |
|__________________________________________________________________________________|
__________________________________________________________________________________
| |
| WARNING NO. 2 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OF THE FINE AND COSTS |
| WITHIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” SECTION OF |
| THE STATEMENT OF OFFENCE OR IN THE DOCUMENT REFERRED TO, YOU WILL BE DEEMED TO |
| HAVE ENTERED A PLEA OF NOT GUILTY. PROCEEDINGS WILL THEN BE TRIED IN YOUR |
| ABSENCE AND JUDGMENT WILL BE RENDERED WITHOUT FURTHER NOTICE. |
|__________________________________________________________________________________|
IF YOU ARE CONVICTED BY DEFAULT, ADDITIONAL COSTS MAY BE IMPOSED..
RIGHT TO LEGAL COUNSEL
You have the right to seek legal counsel before entering a plea or making a preliminary application.
__________________________________________________________________________________
| |
| INFORMATION |
| |
| |
| |
| PROSECUTOR’S ADDRESS (IF APPLICABLE) |
|__________________________________________________________________________________|
| |
| INFORMATION |
| |
| |
| |
| PROSECUTOR’S ADDRESS (IF APPLICABLE) |
|__________________________________________________________________________________|
DEFENDANT
CANADA
PROVINCE OF QUÉBEC
PLEA FORM
Judicial district
Licence plate number Province/State Vehicle make Model
Date of offence (Y-M-D)
PLEA OF GUILTY
c I plead guilty Signature:
Capacity (title) Date
PAYMENT
If you plead guilty to the offence charged, you must pay the Total Amount indicated, or your may be required to pay and additional amount as costs.
Your plea and your payment must be sent no later than 30 days after the date of service appearing at the bottom of this form or, if service was made by mail, the date on the notice of receipt or delivery or on the envelope.
Your plea and payment must be sent to:
RETURN THIS FORM WITH YOUR PAYMENT
$
PENALTY
Minimum fine Costs Contribution Total amount
$ + $ + $ = $
c If this box is checked, towing fees of $ __________________have been added.
AMOUT PAID
$
Date of service (Y-M-D) Time (H-M)
PLEA OF NOT GUILTY
To enter a plea of not guilty, you must complete this form.
c I plead not guilty Signature:
Surname (in block letters) Given name
No. and street Apt.
Town/City
Province Postal code Date (Y-M-D)
Licence plate number Province/State Vehicle make Model
If this statement of offence is maintained, you will be notified by the clerk of the competent courts of the place, date and time set for the trial of the proceedings.
This plea of not guilty must be sent to the following address, no later than 30 days after the date of service:
Address where plea form must be sent
CASHIER’S STAMP
PROVINCE OF QUÉBEC
PLEA FORM
Judicial district
Licence plate number Province/State Vehicle make Model
Date of offence (Y-M-D)
PLEA OF GUILTY
c I plead guilty Signature:
Capacity (title) Date
PAYMENT
If you plead guilty to the offence charged, you must pay the Total Amount indicated, or your may be required to pay and additional amount as costs.
Your plea and your payment must be sent no later than 30 days after the date of service appearing at the bottom of this form or, if service was made by mail, the date on the notice of receipt or delivery or on the envelope.
Your plea and payment must be sent to:
RETURN THIS FORM WITH YOUR PAYMENT
$
PENALTY
Minimum fine Costs Contribution Total amount
$ + $ + $ = $
c If this box is checked, towing fees of $ __________________have been added.
AMOUT PAID
$
Date of service (Y-M-D) Time (H-M)
PLEA OF NOT GUILTY
To enter a plea of not guilty, you must complete this form.
c I plead not guilty Signature:
Surname (in block letters) Given name
No. and street Apt.
Town/City
Province Postal code Date (Y-M-D)
Licence plate number Province/State Vehicle make Model
If this statement of offence is maintained, you will be notified by the clerk of the competent courts of the place, date and time set for the trial of the proceedings.
This plea of not guilty must be sent to the following address, no later than 30 days after the date of service:
Address where plea form must be sent
CASHIER’S STAMP
SCHEDULE IV
(s. 23, 1st par., subpar. 4)
000000 0000000000
CANADA
PROVINCE OF QUÉBEC
STATEMENT OF OFFENCE
(PARKING)
Judicial district
Prosecutor
Vehicle owner
Defendant
PAYMENT: SEE PLEA
FORM
VEHICLE
Licence plate number Prov/State Vehicle make Model
Temporary registration certificate Towing/Vehicle towed to
Surname Given name
Address Apt.
Town/City Province/State Postal code
Time of the offence Date of offence (Y-M-D)
From To
PLACE
District Parking sign Parking meter number
Location
Highway/Road Direction Location Unit
1- Facing
2- Near
3- Opposite
4- Inters.
5- Rear
Side
1- North
2- South
3- East
4- West
DESCRIPTION OF THE OFFENCE
$
PENALTY
Minimum fine Costs Contribution Total amount
$ + $ + $ = $
c If this box is checked, towing fees of $ __________________have been added.
ATTESTATION/SERVICE
ATTESTATION
I, the undersigned, certify that I personally witnessed the facts set out in this statement of offence and have reasonable grounds to believe that the above-described offence has been committed.
Name (in block letters)
Person entrusted with the enforcement of the Act Capacity
c I did not deliver the duplicate of the statement
c I witnessed the facts and served the duplicate of the statement (only one signature required)
Signature
SERVICE
I certify that I delivered a duplicate of the statement of offence
c at the time of the offence
c subsequent to the commission of the offence
c by leaving it in a conspicuous place on the vehicle
c in another manner (specify):
Name (in block letters) c same as attestation
Person entrusted with the enforcement of the Act Capacity
Date of service (Y-M-D) Time (H-M)
Signature
IMPORTANT
PLEASE READ WARGNING NO. 1 ON THE BACK.
HOWEVER, IF YOU ARE UNDER 18 YEARS OF AGE OR IF THIS BOX IS CHECKED c
PLEASE READ WARNING NO. 2 ON THE BACK.
DEFENDANT
CANADA
PROVINCE OF QUÉBEC
STATEMENT OF OFFENCE
(PARKING)
Judicial district
Prosecutor
Vehicle owner
Defendant
PAYMENT: SEE PLEA
FORM
VEHICLE
Licence plate number Prov/State Vehicle make Model
Temporary registration certificate Towing/Vehicle towed to
Surname Given name
Address Apt.
Town/City Province/State Postal code
Time of the offence Date of offence (Y-M-D)
From To
PLACE
District Parking sign Parking meter number
Location
Highway/Road Direction Location Unit
1- Facing
2- Near
3- Opposite
4- Inters.
5- Rear
Side
1- North
2- South
3- East
4- West
DESCRIPTION OF THE OFFENCE
$
PENALTY
Minimum fine Costs Contribution Total amount
$ + $ + $ = $
c If this box is checked, towing fees of $ __________________have been added.
ATTESTATION/SERVICE
ATTESTATION
I, the undersigned, certify that I personally witnessed the facts set out in this statement of offence and have reasonable grounds to believe that the above-described offence has been committed.
Name (in block letters)
Person entrusted with the enforcement of the Act Capacity
c I did not deliver the duplicate of the statement
c I witnessed the facts and served the duplicate of the statement (only one signature required)
Signature
SERVICE
I certify that I delivered a duplicate of the statement of offence
c at the time of the offence
c subsequent to the commission of the offence
c by leaving it in a conspicuous place on the vehicle
c in another manner (specify):
Name (in block letters) c same as attestation
Person entrusted with the enforcement of the Act Capacity
Date of service (Y-M-D) Time (H-M)
Signature
IMPORTANT
PLEASE READ WARGNING NO. 1 ON THE BACK.
HOWEVER, IF YOU ARE UNDER 18 YEARS OF AGE OR IF THIS BOX IS CHECKED c
PLEASE READ WARNING NO. 2 ON THE BACK.
DEFENDANT
STATEMENT OF OFFENCE
Penal proceedings are instituted by means of a statement of offence and commence on the date of service of the statement of offence.
PLEA
You are required to enter a plea of guilty or not guilty within 30 days after the date of service indicated in the “SERVICE” section of the statement of offence.
If the defendant is a legal person, a director or officer of the defendant must sign the plea and indicate his or her capacity.
PLEA OF GUILTY AND PAYMENT
If you plead guilty to the offence charged, please use the attached plea form to:
- enter your plea, and
- pay (in Canadian funds) the total amount of the fine, costs and contribution indicated on the statement of offence.
The contribution is used to assist victims of crime, as provided in article 8.1 of the Code of Penal Procedure (c. C-25.1).
The plea and the payment may be send to the address indicated on the plea form or ..........
Payment may be made (indicate method of payment).
A defendant who enters a plea of guilty is deemed to have been convicted of the offence.
Additional costs may be imposed if the total amount of the fine, costs and contribution is not transmitted with the plea of guilty.
PLEA OF NOT GUILTY
If you plead not guilty to the offence, please enter your plea on the back of the attached plea form. Your plea must be sent to the address indicate on the plea form.
You will be notified by the clerk of the competent court of the place, date and time set for the trial.
PRELIMINARY APPLICATIONS
To prepare your defence, you may file with your plea of not guilty a preliminary application as provided in articles 168 to 186 of the Code of Penal Procedure.
FAILURE TO ENTER A PLEA AND PAY THE TOTAL AMOUNT OF THE FINE AND COSTS
__________________________________________________________________________________
| |
| WARNING NO. 1 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OR A PART OF THE FINE |
| AND COSTS WITNIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” |
| SECTION OF THE STATEMENT OF OFFENCE, YOU WILL BE DEEMED NOT TO CONTEST THE |
| PROCEEDINGS AND MAY BE CONVICTED BY DEFAULT (IN YOUR ABSENCE) WITHOUT AN |
| OPPORTUNITY TO BE HEARD. |
|__________________________________________________________________________________|
__________________________________________________________________________________
| |
| WARNING NO. 2 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OF THE FINE AND COSTS |
| WITHIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” SECTION OF |
| THE STATEMENT OF OFFENCE OR IN THE DOCUMENT REFERRED TO, YOU WILL BE DEEMED TO |
| HAVE ENTERED A PLEA OF NOT GUILTY. PROCEEDINGS WILL THEN BE TRIED IN YOUR |
| ABSENCE AND JUDGMENT WILL BE RENDERED WITHOUT FURTHER NOTICE. |
|__________________________________________________________________________________|
| |
| WARNING NO. 1 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OR A PART OF THE FINE |
| AND COSTS WITNIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” |
| SECTION OF THE STATEMENT OF OFFENCE, YOU WILL BE DEEMED NOT TO CONTEST THE |
| PROCEEDINGS AND MAY BE CONVICTED BY DEFAULT (IN YOUR ABSENCE) WITHOUT AN |
| OPPORTUNITY TO BE HEARD. |
|__________________________________________________________________________________|
__________________________________________________________________________________
| |
| WARNING NO. 2 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OF THE FINE AND COSTS |
| WITHIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” SECTION OF |
| THE STATEMENT OF OFFENCE OR IN THE DOCUMENT REFERRED TO, YOU WILL BE DEEMED TO |
| HAVE ENTERED A PLEA OF NOT GUILTY. PROCEEDINGS WILL THEN BE TRIED IN YOUR |
| ABSENCE AND JUDGMENT WILL BE RENDERED WITHOUT FURTHER NOTICE. |
|__________________________________________________________________________________|
IF YOU ARE CONVICTED BY DEFAULT, ADDITIONAL COSTS MAY BE IMPOSED..
RIGHT TO LEGAL COUNSEL
You have the right to seek legal counsel before entering a plea or making a preliminary application.
__________________________________________________________________________________
| |
| INFORMATION |
| |
| |
| |
| PROSECUTOR’S ADDRESS (IF APPLICABLE) |
|__________________________________________________________________________________|
| |
| INFORMATION |
| |
| |
| |
| PROSECUTOR’S ADDRESS (IF APPLICABLE) |
|__________________________________________________________________________________|
DEFENDANT
CANADA
PROVINCE OF QUÉBEC
PLEA FORM
Judicial district
Licence plate number Province/State Vehicle make Model
Date of offence (Y-M-D)
PLEA OF GUILTY
c I plead guilty Signature:
Capacity (title) Date
PAYMENT
If you plead guilty to the offence charged, you must pay the Total Amount indicated, or your may be required to pay and additional amount as costs.
Your plea and your payment must be sent no later than 30 days after the date of service appearing at the bottom of this form or, if service was made by mail, the date on the notice of receipt or delivery or on the envelope.
Your plea and payment must be sent to:
RETURN THIS FORM WITH YOUR PAYMENT
$
PENALTY
Minimum fine Costs Contribution Total amount
$ + $ + $ = $
c If this box is checked, towing fees of $ __________________have been added.
AMOUT PAID
$
Date of service (Y-M-D) Time (H-M)
PLEA OF NOT GUILTY
To enter a plea of not guilty, you must complete this form.
c I plead not guilty Signature:
Surname (in block letters) Given name
No. and street Apt.
Town/City
Province Postal code Date (Y-M-D)
Licence plate number Province/State Vehicle make Model
If this statement of offence is maintained, you will be notified by the clerk of the competent courts of the place, date and time set for the trial of the proceedings.
This plea of not guilty must be sent to the following address, no later than 30 days after the date of service:
Address where plea form must be sent
CASHIER’S STAMP
PROVINCE OF QUÉBEC
PLEA FORM
Judicial district
Licence plate number Province/State Vehicle make Model
Date of offence (Y-M-D)
PLEA OF GUILTY
c I plead guilty Signature:
Capacity (title) Date
PAYMENT
If you plead guilty to the offence charged, you must pay the Total Amount indicated, or your may be required to pay and additional amount as costs.
Your plea and your payment must be sent no later than 30 days after the date of service appearing at the bottom of this form or, if service was made by mail, the date on the notice of receipt or delivery or on the envelope.
Your plea and payment must be sent to:
RETURN THIS FORM WITH YOUR PAYMENT
$
PENALTY
Minimum fine Costs Contribution Total amount
$ + $ + $ = $
c If this box is checked, towing fees of $ __________________have been added.
AMOUT PAID
$
Date of service (Y-M-D) Time (H-M)
PLEA OF NOT GUILTY
To enter a plea of not guilty, you must complete this form.
c I plead not guilty Signature:
Surname (in block letters) Given name
No. and street Apt.
Town/City
Province Postal code Date (Y-M-D)
Licence plate number Province/State Vehicle make Model
If this statement of offence is maintained, you will be notified by the clerk of the competent courts of the place, date and time set for the trial of the proceedings.
This plea of not guilty must be sent to the following address, no later than 30 days after the date of service:
Address where plea form must be sent
CASHIER’S STAMP
