Vol. 146, No. 5 — February 29, 2012
Form 4 / AFFIDAVIT
Court File No.
COURT OF ONTARIO
(Superior Court of Justice)
HER MAJESTY THE QUEEN
specify name of accused)
AFFIDAVIT OF (name)
(Criminal Proceedings Rules, Rule 4, Form 4)
I, (full name of deponent), of the (City, Town, etc.) of __________, in the (County, District, Regional Municipality, etc.), (set out the deponent’s capacity), MAKE OATH AND SAY (or AFFIRM):
1. (set out the statements of fact in consecutively numbered paragraphs, with each paragraph being confined as far as possible to a particular statement of fact)
SWORN (or Affirmed) before me at the (City, Town, etc.) of __________ in the (County, District, Regional Municipality, etc.) of __________________ on (date), 2____.
Commissioner for Taking Oaths
(or as may be)