Schedule “A”

C.A. C. No.

NOVA SCOTIA COURT OF APPEAL

BETWEEN:

                                                                                          Appellant

- and -

                              Her Majesty the Queen

                                                                                Respondent

 MOTION FOR WARRANT TO CONVEY

1. That I am ______________________, of _________________________ and the statements of fact herein sworn are true to the best of my knowledge and belief.

2. That the Appellant is imprisoned in the (federal penitentiary, provincial institution) at (full civic address), in the Province of (Nova Scotia or other province).

3. That the Appellant has filed with the Registrar of this Court a Notice of Appeal from (his/her) (conviction/sentence/conviction and sentence) following (his/her) conviction for (offence) contrary to (s. ) of the Criminal Code of Canada, for which (he/she) was sentenced to (if sentence is an issue).

4. (If applicable) That the Appellant has filed with the Registrar of this Court a Notice of Motion (specific Chambers application, i.e. release pending appeal, etc), on the ___ day of ___, 200.

5. That the Appellant (is/is not) represented by counsel in (his/her) appeal or on (his/her) motion.

6. That the Appellant has requested that (he/she) be personally present on the hearing of (his/her) (appeal/motion).

7. That on the (day) of (month) 200 , at the hour of ( ) o’clock in the (forenoon/afternoon), before (a Chambers judge/a Panel of three (3) judges), this Court will hear the Appellant’s (appeal/motion for ) and/or (that a Judge of the Nova Scotia Court of Appeal has directed that the Appellant be present in Chambers of the Court of Appeal) at The Law Courts building, 1815 Upper Water Street, Halifax, Nova Scotia .

8. That I wish to apply pursuant to ss. 527 and 688 of the Criminal Code of Canada for an order in writing that the Appellant be brought before the Nova Scotia Court of Appeal at The Law Courts, Halifax, Nova Scotia on ____, the (day) day of (month), 200 at ( ) o’clock in the (forenoon/afternoon), to make submissions in (his/her) (appeal/Chambers motion).

SWORN TO at Halifax, in the Halifax )

Regional Municipality, Province of )

Nova Scotia, this Day of _____, 200 )

                                                                      )

                                                                      )

                                                                      )

                                                                      )

____________________________________ ____________________________________

A Barrister of the Supreme Court of

Nova Scotia Your name (deponent)