Versions of Form

Offence Sentence Remarks(state offence of which offender was convicted)(state term of imprisonment for the offence and, in case of imprisonment for default of payment of fine, so indicate together with the amount of it and applicable costs and whether payable immediately or within a time fixed)(state the amount of time spent in custody before sentencing, the term of imprisonment that would have been imposed before any credit was granted under subsection 719(3) or (3.1), the amount of time credited, if any, and whether the sentence is consecutive or concurrent, and specify consecutive to or concurrent with what other sentence) 1. 2. 3. 4.

Offence Sentence Remarks(state offence of which offender was convicted)(state term of imprisonment for the offence and, in case of imprisonment for default of payment of fine, so indicate together with the amount thereof and costs applicable and whether payable forthwith or within a time fixed)(state whether the sentence is consecutive or concurrent, and specify consecutive or concurrent to/with what other sentence) 1. 2. 3. 4. Clerk of the Court, Justice, Judge or Provincial Court Judge