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C-25.1, r. 1 - Regulation respecting the form of statements of offence
Schedule
Disposition versions
SCHEDULE V
(Revoked)
SCHEDULE V
(s. 23, 2nd par.)
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 attached plea form. Your plea must be sent to the address indicated 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..
DEMERIT POINT
The demerit points indicated on the statement of offence serve only as a guideline. The Société de l’assurance automobile du Québec is responsible for registering demerit points in a defendant’s record.
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 V
(s. 23, 2nd par.)
000000 0000000000
STATEMENT OF OFFENCE
Judicial district
Court office record number
Prosecutor
A DEFENDANT
1. Mr.
2. Ms.
3. Legal person
4. Owner to be identified c
Surname Given name
Address Apt.
Locality Prov/State Postal code
Confirmation of identity Prov/State c Non resident
c Under 18 years of age
B VEH
Licence plate No. certificate c Temporary registration Expiry Prov/State Vehicle make
Model Year No. of axles declared Net weight declared
C OFFENCE
c Highway Safety Code
c Municipal traffic or parking by-law
c Other law or regulation
Title of the law or regulation
Section or article Code Defendant code Vehicle code
DESCRIPTION OF THE OFFENCE
Speed recorded km/h
Speed limit km/h
By c 1. Radar
2. Vehicle
3. Air
Weigh/dimension recorded c kg
c m
Allowable weight/dimension c kg
c m
Date of offence (Y-M-D)
Time from ____________ to ____________
Demerit points
Thaw period c
D PLACE
Location
Highway/Road
Direction
Location
Unit
1. Facing Side
2. Near 1- North
3. Opposite 2- South
4. Inters. 3- East
5. Rear c 4- West c
E
1- Driver
2- Operator
3- Driver = Operator c
Surname Given name
Confirmation of identity Prov/State O.O.H.V. c
F
PENALTY Minimum fine Costs Contribution Total amount
$ + $ + $ = $
G ATTESTATION/SERVICE
ATTESTATION
I, the undersigned, certify that I personally witnessed the facts set out in
c A c B c C c D c E,
and (if applicable)
certify that _________________________, peace officer, badge number _______________________witnessed the facts set out in
c A c B c C c D c E
and I have reasonable grounds to believe that the offence described in C was committed.
c I did not deliver a duplicate of the statement
Name (in block letters))
c Peace officer Badge number Unit
c Person entrusted with the enforcement of the Act Capacity
Signature or validation code
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 to the defendant c to the driver
c by leaving it an a conspicuous place on the vehicle
c in another manner (specify)
Name (in block letters) c same as attestation
c Peace officer Badge number Unit
c Person entrusted with the enforcement of the Act Capacity
Time (H-M) Date of service (Y-M-D)
Signature or validation code
H IMPORTANT
PLEASE READ WARNING NO. 1 ONTHE BACK.
HOWEVER, IF YOU ARE UNDER 18 YEARS OF AGE OR IF THIS BOX IS CHECKED c.
PLEASE READ WARING NO. 2 ON THE BACK.
HARD-COPY CONVERSION
I CERTIFY THAT THIS DOCUMENT IS TRUE TO ITS DUPLICATE IN ELECTRONIC FORM.
Date (Y-M-D)
Time (H-M-S)
Authorized person
Name
Capacity
Validation code
STATEMENT OF OFFENCE
Judicial district
Court office record number
Prosecutor
A DEFENDANT
1. Mr.
2. Ms.
3. Legal person
4. Owner to be identified c
Surname Given name
Address Apt.
Locality Prov/State Postal code
Confirmation of identity Prov/State c Non resident
c Under 18 years of age
B VEH
Licence plate No. certificate c Temporary registration Expiry Prov/State Vehicle make
Model Year No. of axles declared Net weight declared
C OFFENCE
c Highway Safety Code
c Municipal traffic or parking by-law
c Other law or regulation
Title of the law or regulation
Section or article Code Defendant code Vehicle code
DESCRIPTION OF THE OFFENCE
Speed recorded km/h
Speed limit km/h
By c 1. Radar
2. Vehicle
3. Air
Weigh/dimension recorded c kg
c m
Allowable weight/dimension c kg
c m
Date of offence (Y-M-D)
Time from ____________ to ____________
Demerit points
Thaw period c
D PLACE
Location
Highway/Road
Direction
Location
Unit
1. Facing Side
2. Near 1- North
3. Opposite 2- South
4. Inters. 3- East
5. Rear c 4- West c
E
1- Driver
2- Operator
3- Driver = Operator c
Surname Given name
Confirmation of identity Prov/State O.O.H.V. c
F
PENALTY Minimum fine Costs Contribution Total amount
$ + $ + $ = $
G ATTESTATION/SERVICE
ATTESTATION
I, the undersigned, certify that I personally witnessed the facts set out in
c A c B c C c D c E,
and (if applicable)
certify that _________________________, peace officer, badge number _______________________witnessed the facts set out in
c A c B c C c D c E
and I have reasonable grounds to believe that the offence described in C was committed.
c I did not deliver a duplicate of the statement
Name (in block letters))
c Peace officer Badge number Unit
c Person entrusted with the enforcement of the Act Capacity
Signature or validation code
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 to the defendant c to the driver
c by leaving it an a conspicuous place on the vehicle
c in another manner (specify)
Name (in block letters) c same as attestation
c Peace officer Badge number Unit
c Person entrusted with the enforcement of the Act Capacity
Time (H-M) Date of service (Y-M-D)
Signature or validation code
H IMPORTANT
PLEASE READ WARNING NO. 1 ONTHE BACK.
HOWEVER, IF YOU ARE UNDER 18 YEARS OF AGE OR IF THIS BOX IS CHECKED c.
PLEASE READ WARING NO. 2 ON THE BACK.
HARD-COPY CONVERSION
I CERTIFY THAT THIS DOCUMENT IS TRUE TO ITS DUPLICATE IN ELECTRONIC FORM.
Date (Y-M-D)
Time (H-M-S)
Authorized person
Name
Capacity
Validation code
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 attached plea form. Your plea must be sent to the address indicated 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..
DEMERIT POINT
The demerit points indicated on the statement of offence serve only as a guideline. The Société de l’assurance automobile du Québec is responsible for registering demerit points in a defendant’s record.
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 V
(s. 23, 2nd par.)
000000 0000000000
STATEMENT OF OFFENCE
Judicial district
Court office record number
Prosecutor
A DEFENDANT
1. Mr.
2. Ms.
3. Legal person
4. Owner to be identified c
Surname Given name
Address Apt.
Locality Prov/State Postal code
Confirmation of identity Prov/State c Non resident
c Under 18 years of age
B VEH
Licence plate No. certificate c Temporary registration Expiry Prov/State Vehicle make
Model Year No. of axles declared Net weight declared
C OFFENCE
c Highway Safety Code
c Municipal traffic or parking by-law
c Other law or regulation
Title of the law or regulation
Section or article Code Defendant code Vehicle code
DESCRIPTION OF THE OFFENCE
Speed recorded km/h
Speed limit km/h
By c 1. Radar
2. Vehicle
3. Air
Weigh/dimension recorded c kg
c m
Allowable weight/dimension c kg
c m
Date of offence (Y-M-D)
Time from ____________ to ____________
Demerit points
Thaw period c
D PLACE
Location
Highway/Road
Direction
Location
Unit
1. Facing Side
2. Near 1- North
3. Opposite 2- South
4. Inters. 3- East
5. Rear c 4- West c
E
1- Driver
2- Operator
3- Driver = Operator c
Surname Given name
Confirmation of identity Prov/State O.O.H.V. c
F
PENALTY Minimum fine Costs Contribution Total amount
$ + $ + $ = $
G ATTESTATION/SERVICE
ATTESTATION
I, the undersigned, certify that I personally witnessed the facts set out in
c A c B c C c D c E,
and (if applicable)
certify that _________________________, peace officer, badge number _______________________witnessed the facts set out in
c A c B c C c D c E
and I have reasonable grounds to believe that the offence described in C was committed.
c I did not deliver a duplicate of the statement
Name (in block letters))
c Peace officer Badge number Unit
c Person entrusted with the enforcement of the Act Capacity
Signature or validation code
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 to the defendant c to the driver
c by leaving it an a conspicuous place on the vehicle
c in another manner (specify)
Name (in block letters) c same as attestation
c Peace officer Badge number Unit
c Person entrusted with the enforcement of the Act Capacity
Time (H-M) Date of service (Y-M-D)
Signature or validation code
H IMPORTANT
PLEASE READ WARNING NO. 1 ONTHE BACK.
HOWEVER, IF YOU ARE UNDER 18 YEARS OF AGE OR IF THIS BOX IS CHECKED c.
PLEASE READ WARING NO. 2 ON THE BACK.
HARD-COPY CONVERSION
I CERTIFY THAT THIS DOCUMENT IS TRUE TO ITS DUPLICATE IN ELECTRONIC FORM.
Date (Y-M-D)
Time (H-M-S)
Authorized person
Name
Capacity
Validation code
STATEMENT OF OFFENCE
Judicial district
Court office record number
Prosecutor
A DEFENDANT
1. Mr.
2. Ms.
3. Legal person
4. Owner to be identified c
Surname Given name
Address Apt.
Locality Prov/State Postal code
Confirmation of identity Prov/State c Non resident
c Under 18 years of age
B VEH
Licence plate No. certificate c Temporary registration Expiry Prov/State Vehicle make
Model Year No. of axles declared Net weight declared
C OFFENCE
c Highway Safety Code
c Municipal traffic or parking by-law
c Other law or regulation
Title of the law or regulation
Section or article Code Defendant code Vehicle code
DESCRIPTION OF THE OFFENCE
Speed recorded km/h
Speed limit km/h
By c 1. Radar
2. Vehicle
3. Air
Weigh/dimension recorded c kg
c m
Allowable weight/dimension c kg
c m
Date of offence (Y-M-D)
Time from ____________ to ____________
Demerit points
Thaw period c
D PLACE
Location
Highway/Road
Direction
Location
Unit
1. Facing Side
2. Near 1- North
3. Opposite 2- South
4. Inters. 3- East
5. Rear c 4- West c
E
1- Driver
2- Operator
3- Driver = Operator c
Surname Given name
Confirmation of identity Prov/State O.O.H.V. c
F
PENALTY Minimum fine Costs Contribution Total amount
$ + $ + $ = $
G ATTESTATION/SERVICE
ATTESTATION
I, the undersigned, certify that I personally witnessed the facts set out in
c A c B c C c D c E,
and (if applicable)
certify that _________________________, peace officer, badge number _______________________witnessed the facts set out in
c A c B c C c D c E
and I have reasonable grounds to believe that the offence described in C was committed.
c I did not deliver a duplicate of the statement
Name (in block letters))
c Peace officer Badge number Unit
c Person entrusted with the enforcement of the Act Capacity
Signature or validation code
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 to the defendant c to the driver
c by leaving it an a conspicuous place on the vehicle
c in another manner (specify)
Name (in block letters) c same as attestation
c Peace officer Badge number Unit
c Person entrusted with the enforcement of the Act Capacity
Time (H-M) Date of service (Y-M-D)
Signature or validation code
H IMPORTANT
PLEASE READ WARNING NO. 1 ONTHE BACK.
HOWEVER, IF YOU ARE UNDER 18 YEARS OF AGE OR IF THIS BOX IS CHECKED c.
PLEASE READ WARING NO. 2 ON THE BACK.
HARD-COPY CONVERSION
I CERTIFY THAT THIS DOCUMENT IS TRUE TO ITS DUPLICATE IN ELECTRONIC FORM.
Date (Y-M-D)
Time (H-M-S)
Authorized person
Name
Capacity
Validation code
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 attached plea form. Your plea must be sent to the address indicated 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..
DEMERIT POINT
The demerit points indicated on the statement of offence serve only as a guideline. The Société de l’assurance automobile du Québec is responsible for registering demerit points in a defendant’s record.
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 V
(s. 23, 2nd par.)
000000 0000000000
STATEMENT OF OFFENCE
Judicial district
Court office record number
Prosecutor
A DEFENDANT
1. Mr.
2. Ms.
3. Legal person
4. Owner to be identified c
Surname Given name
Address Apt.
Locality Prov/State Postal code
Confirmation of identity Prov/State c Non resident
c Under 18 years of age
B VEH
Licence plate No. certificate c Temporary registration Expiry Prov/State Vehicle make
Model Year No. of axles declared Net weight declared
C OFFENCE
c Highway Safety Code
c Municipal traffic or parking by-law
c Other law or regulation
Title of the law or regulation
Section or article Code Defendant code Vehicle code
DESCRIPTION OF THE OFFENCE
Speed recorded km/h
Speed limit km/h
By c 1. Radar
2. Vehicle
3. Air
Weigh/dimension recorded c kg
c m
Allowable weight/dimension c kg
c m
Date of offence (Y-M-D)
Time from ____________ to ____________
Demerit points
Thaw period c
D PLACE
Location
Highway/Road
Direction
Location
Unit
1. Facing Side
2. Near 1- North
3. Opposite 2- South
4. Inters. 3- East
5. Rear c 4- West c
E
1- Driver
2- Operator
3- Driver = Operator c
Surname Given name
Confirmation of identity Prov/State O.O.H.V. c
F
PENALTY Minimum fine Costs Contribution Total amount
$ + $ + $ = $
G ATTESTATION/SERVICE
ATTESTATION
I, the undersigned, certify that I personally witnessed the facts set out in
c A c B c C c D c E,
and (if applicable)
certify that _________________________, peace officer, badge number _______________________witnessed the facts set out in
c A c B c C c D c E
and I have reasonable grounds to believe that the offence described in C was committed.
c I did not deliver a duplicate of the statement
Name (in block letters))
c Peace officer Badge number Unit
c Person entrusted with the enforcement of the Act Capacity
Signature or validation code
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 to the defendant c to the driver
c by leaving it an a conspicuous place on the vehicle
c in another manner (specify)
Name (in block letters) c same as attestation
c Peace officer Badge number Unit
c Person entrusted with the enforcement of the Act Capacity
Time (H-M) Date of service (Y-M-D)
Signature or validation code
H IMPORTANT
PLEASE READ WARNING NO. 1 ONTHE BACK.
HOWEVER, IF YOU ARE UNDER 18 YEARS OF AGE OR IF THIS BOX IS CHECKED c.
PLEASE READ WARING NO. 2 ON THE BACK.
HARD-COPY CONVERSION
I CERTIFY THAT THIS DOCUMENT IS TRUE TO ITS DUPLICATE IN ELECTRONIC FORM.
Date (Y-M-D)
Time (H-M-S)
Authorized person
Name
Capacity
Validation code
STATEMENT OF OFFENCE
Judicial district
Court office record number
Prosecutor
A DEFENDANT
1. Mr.
2. Ms.
3. Legal person
4. Owner to be identified c
Surname Given name
Address Apt.
Locality Prov/State Postal code
Confirmation of identity Prov/State c Non resident
c Under 18 years of age
B VEH
Licence plate No. certificate c Temporary registration Expiry Prov/State Vehicle make
Model Year No. of axles declared Net weight declared
C OFFENCE
c Highway Safety Code
c Municipal traffic or parking by-law
c Other law or regulation
Title of the law or regulation
Section or article Code Defendant code Vehicle code
DESCRIPTION OF THE OFFENCE
Speed recorded km/h
Speed limit km/h
By c 1. Radar
2. Vehicle
3. Air
Weigh/dimension recorded c kg
c m
Allowable weight/dimension c kg
c m
Date of offence (Y-M-D)
Time from ____________ to ____________
Demerit points
Thaw period c
D PLACE
Location
Highway/Road
Direction
Location
Unit
1. Facing Side
2. Near 1- North
3. Opposite 2- South
4. Inters. 3- East
5. Rear c 4- West c
E
1- Driver
2- Operator
3- Driver = Operator c
Surname Given name
Confirmation of identity Prov/State O.O.H.V. c
F
PENALTY Minimum fine Costs Contribution Total amount
$ + $ + $ = $
G ATTESTATION/SERVICE
ATTESTATION
I, the undersigned, certify that I personally witnessed the facts set out in
c A c B c C c D c E,
and (if applicable)
certify that _________________________, peace officer, badge number _______________________witnessed the facts set out in
c A c B c C c D c E
and I have reasonable grounds to believe that the offence described in C was committed.
c I did not deliver a duplicate of the statement
Name (in block letters))
c Peace officer Badge number Unit
c Person entrusted with the enforcement of the Act Capacity
Signature or validation code
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 to the defendant c to the driver
c by leaving it an a conspicuous place on the vehicle
c in another manner (specify)
Name (in block letters) c same as attestation
c Peace officer Badge number Unit
c Person entrusted with the enforcement of the Act Capacity
Time (H-M) Date of service (Y-M-D)
Signature or validation code
H IMPORTANT
PLEASE READ WARNING NO. 1 ONTHE BACK.
HOWEVER, IF YOU ARE UNDER 18 YEARS OF AGE OR IF THIS BOX IS CHECKED c.
PLEASE READ WARING NO. 2 ON THE BACK.
HARD-COPY CONVERSION
I CERTIFY THAT THIS DOCUMENT IS TRUE TO ITS DUPLICATE IN ELECTRONIC FORM.
Date (Y-M-D)
Time (H-M-S)
Authorized person
Name
Capacity
Validation code
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 attached plea form. Your plea must be sent to the address indicated 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..
DEMERIT POINT
The demerit points indicated on the statement of offence serve only as a guideline. The Société de l’assurance automobile du Québec is responsible for registering demerit points in a defendant’s record.
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
