NOTICE OF APPEAL – FORM 8 PAGE 3

Notice of Appeal – Form 8 - page 3 File No. _____________________

The Queen’s Bench

______________ Centre

BETWEEN:

HER MAJESTY THE QUEEN

(applicant or respondent)

-and-

(applicant or respondent)

NOTICE OF APPEAL

(name, address, email address and telephone

and fax numbers of the person filing the document)

THE QUEEN’S BENCH

________________Centre

BETWEEN:

HER MAJESTY THE QUEEN

(applicant or respondent)

-and-

(applicant or respondent)

NOTICE OF APPEAL

TAKE NOTICE that the Appellant appeals from the following:

☐ ACQUITTAL ☐ CONVICTION ☐ SENTENCE ☐ ORDER

1 Place of conviction

☐ 408 York Avenue, Winnipeg, Manitoba

☐ 373 Broadway, Winnipeg, Manitoba

☐ other: _________________________________________________

2 Court appealed from: ___________________________________________________

3 Offence(s) in question:___________________________________________________

4 Sentence imposed, if applicable:___________________________________________

5 Date of acquittal, conviction or order: ______________________________________

6 Date of sentence:_______________________________________________________

GROUNDS OF APPEAL (state concisely): ______________________________________

_______________________________________________________________________

Relief sought: ___________________________________________________________

_______________________________________________________________________

The address for service of the appellant is: ____________________________________

_______________________________________________________________________
(address, email address and telephone and fax numbers of the appellant)

☐ No evidence recorded

☐ Evidence recorded — transcript ordered

☐ Appellant seeks to proceed under section 830 of the Code on agreed facts

☐ Appellant will request a de novo hearing under section 822 of the Code (Notice of Motion is attached)

________________________________ ____________________________________
(date) (signature of appellant or counsel)

________________________________
(print name of appellant or counsel)