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FORM 79.04A

C A N A D A,

PROVINCE OF PRINCE EDWARD ISLAND,

SUPREME COURT OF PRINCE EDWARD ISLAND — TRIAL DIVISION

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Application of (given names and surname of the applicant) made pursuant to section 745 of the Criminal Code

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Affidavit

I, the undersigned, (given names and surname of the applicant), currently detained at (name and place of the institution), in the Province of blank line, make oath and say as follows:

  • 1 I am the applicant.

  • 2 The facts set out in the attached application are true.

(Signature of applicant)

Sworn before me on blank line, 19blank line, at blank line, in the Province of blank line

Commissioner for Oaths

 
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