C-25.1, r. 1 - Regulation respecting the form of statements of offence

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Updated to 21 October 2015
This document has official status.
chapter C-25.1, r. 1
Regulation respecting the form of statements of offence
Code of Penal Procedure
(chapter C-25.1, art. 367, par. 1).
CHAPTER I
METHODS OF GENERATING A STATEMENT OF OFFENCE
DIVISION I
GENERAL
1. The purpose of this Regulation is to establish the form of statements of offence, whether on paper or electronically-generated.
In addition, it will also ensure that paper or electronic forms of statements of offence are interchangeable, that either form may be used concomitantly, and establish that the computer data that constitute the statement in electronic form have the same force as the statement of offence in paper form.
O.C. 1211-97, s. 1.
2. Depending on the context, the expression “statement of offence” refers both to the document comprised of the statement of offence form and the particulars that may be recorded therein, and to each or all of the duplicates of that document intended respectively for the defendant, the prosecutor or the judicial authority.
O.C. 1211-97, s. 2.
3. Unless specifically provided for by an Act or by this Regulation, the defendant, the prosecutor and the judicial authority shall have at their disposal the same information recorded in the statement of offence in respect of a penal proceeding. However, the information concerning the nature of the form or computer security may differ.
O.C. 1211-97, s. 3.
4. A statement of offence form is a document containing headings, key words and pre-printed or pre-programmed texts allowing the optional or compulsory particulars prescribed by an Act or this Regulation to be entered by hand, mechanically or by computer.
It may also contain computer codes, marks or particulars, either underlying or visible, that are specific to the electronic form or are designed to ensure the security of electronic data and documentation in penal matters.
O.C. 1211-97, s. 4; O.C. 973-2003, s. 1.
5. A return document, in paper or in electronic form, shall be attached to the defendant’s statement of offence. It shall contain headings, key words and pre-printed or pre-programmed texts allowing the optional or compulsory particulars prescribed by an Act or this Regulation, including the defendant’s response, to be entered by hand, mechanically or by computer.
Any document in paper form bearing the defendant’s response may, in accordance with this Regulation, be digitized and electronically attached or referenced to a statement of offence in electronic form.
O.C. 1211-97, s. 5; O.C. 973-2003, s. 2.
6. The statement of offence may be generated entirely in paper form or in electronic form, or partly in paper form and partly in electronic form. It may also be drawn up in paper form, then transferred into electronic form by means of digitization, and may then be converted into hard copy.
Thus a statement of offence may be in paper form, either originally or after conversion from electronic form into hard copy; a statement of offence may also be in electronic form, either originally or after digitization from the paper form.
O.C. 1211-97, s. 6.
7. Where the statement of offence is originally produced in paper form, each of the duplicates of the statement of offence constitutes an original document.
O.C. 1211-97, s. 7.
8. Where the statement of offence is generated entirely or partly in electronic form, either originally or after its transfer into electronic form by means of digitization, the computer data that make it possible to display the form or convert into hard copy the form and the particulars recorded therein, in whole or in part, have the same force as an original, if the statement meets the standards provided for in this Regulation.
The computer data have the same force as an original during electronic transfer, transmission, use, storage and archiving in electronic form or by electronic means. This also applies to computer data comprising the digitized statement of offence, whether the form or particulars comprising it were digitized simultaneously or separately.
In the same manner, the computer data that make it possible to display the form bearing the defendant’s response or to convert it into hard copy, have the same force as an original, if the document is produced in accordance with these standards.
O.C. 1211-97, s. 8.
9. Where a statement of offence, generated entirely or partly in electronic form, is converted into hard copy on a pre-printed or pre-programmed form, the first hard-copy statement of offence intended for the defendant, the hard-copy statement of offence that the prosecutor may adduce as evidence and the hard-copy statement of offence intended for the judicial authority have the same force as an original.
Where a digitized statement of offence or the digitized particulars it comprises are converted into hard copy, the hard-copy statement of offence that the prosecutor may adduce as evidence and the hard-copy statement of offence intended for the judicial authority stand in lieu of the original.
O.C. 1211-97, s. 9.
10. A statement of offence in paper form is composed of pages, whereas a statement of offence or part thereof in electronic form is composed of computer data displayed on page screens.
The form and the particulars displayed on the page screens in a statement of offence may be electronically attached or referenced. However, the page screens in a statement of offence or the sections they contain shall be intelligible and shall be accessible on a display surface, either in whole or in part, sequentially or thematically.
O.C. 1211-97, s. 10.
11. The return document or any other document bearing the defendant’s response that is entirely or partly electronically-generated may remain in electronic form and be so used on a display surface, or be converted into hard copy on a pre-printed or pre-programmed statement of offence form, or if digitized, on a page for the purposes of reconstituting the statement.
O.C. 1211-97, s. 11.
12. Where a statement of offence contains more than one count against a single defendant, the statement of offence shall be constituted by using a separate statement of offence form of the appropriate type for each count.
Where a statement of offence contains 2 or more separate counts, the statement of offence forms, in paper or in electronic form, shall be cross-referenced by a designation that refers to the entire statement, and each form bearing one of those counts shall be distinguished by a specific designation.
O.C. 1211-97, s. 12.
13. Where a single charge is brought against 2 or more defendants in a statement of offence, a separate statement of offence form of the appropriate type shall be used for each defendant.
Where a statement of offence names 2 or more defendants, the statement of offence forms, in paper or in electronic form, shall be cross-referenced by a designation that refers to the entire statement, and each form for an individual defendant shall be distinguished by a specific designation.
O.C. 1211-97, s. 13.
DIVISION II
STATEMENT OF OFFENCE ORIGINALLY IN PAPER FORM
14. A statement of offence originally drawn up in paper form shall contain at least 2 pages intended respectively for the defendant and the judicial authority. It may also contain additional pages intended for the prosecutor. A return document in a page format shall be attached to the statement of offence intended for the defendant.
The statement of offence made up of pages comprising computer data is a statement in paper form subject to the standards of this Division and must be signed by hand when issued.
O.C. 1211-97, s. 14.
15. The statement of offence in paper form referred to in subparagraph 1 of the first paragraph of section 23 shall be in a format measuring 21.5 cm wide by 35.5 cm high. The statements of offence in paper form referred to in subparagraphs 2 and 3 of the first paragraph of section 23 may be in a smaller format, but may not be less than 10 cm wide by 20 cm high nor more than 21.5 cm wide by 35.5 cm high. The statement of offence in paper form referred to in subparagraph 4 of the first paragraph of section 23 shall not be less than 9 cm wide by 20 cm high nor more than 21.5 cm wide by 35.5 cm high.
The paper or the reproduction process used shall be such that the handwritten, mechanical or computer entries made on the front of the first page can be accurately reproduced on the front of each page in the statement of offence. However, the pages of the statement of offence may be signed one by one.
The headings, key words and general particulars may be pre-printed or pre-programmed. The type size of the printer or the printing press, as the case may be, shall be no smaller than 6 point.
O.C. 1211-97, s. 15.
DIVISION III
STATEMENT OF OFFENCE ORIGINALLY IN ELECTRONIC FORM
16. A statement of offence generated entirely in electronic form is displayed on page screens containing computer data that corresponds to the front and the back of a page in a statement of offence. The same is true of the return document in a statement of offence, which in such case is displayed on page screens containing computer data that correspond to the front and the back of a return document on a page attached to a statement of offence.
O.C. 1211-97, s. 16.
17. A part of a statement of offence may be originally generated in electronic form. The part so generated is displayed on page screens.
Where only the data corresponding to the front of a statement of offence are generated in electronic form, they may be converted into hard copy on a statement of offence form whose front or back may be either pre-printed or pre-programmed.
A return document in the statement of offence that is generated partly in electronic form may be generated on a pre-printed or pre-programmed form.
O.C. 1211-97, s. 17.
DIVISION IV
DIGITIZED STATEMENT OF OFFENCE
18. A statement of offence intended for the judicial authority and originally drawn up in paper form may be digitized. The front and the back of the form as well as the particulars contained in that statement of offence may be digitized either simultaneously or separately. In the latter case, the front of the digitized statement of offence is displayed on superimposed page screens and the back may be electronically attached or referenced to it.
Where the front of the statement of offence is digitized separately, the statement of offence may be converted into hard copy on a page that is intended to bear the reconstitution of the front of the statement and whose back may be pre-printed or pre-programmed. Where the particulars contained on the front of the statement of offence are digitized separately, the statement may likewise be converted into hard copy on a pre-printed or pre-programmed form.
O.C. 1211-97, s. 18.
DIVISION V
HARD-COPY STATEMENT OF OFFENCE
19. Statements of offence generated entirely or partly in electronic form and digitized statements of offence may be converted into hard copy. In that case, the hard-copy document shall bear an attestation of hard-copy conversion such as provided for in paragraph 5 of section 25.
Where a statement of offence is converted into hard copy, it results from the combination of a virtual part and a material part. The virtual part is comprised of the particulars and the pre-programmed form contained in the statement of offence or in the part of the statement of offence generated in electronic form; in case of digitization, the virtual part is comprised of the digitized form and particulars. The material part is comprised of the statement of offence form in paper form, which may be pre-printed or pre-programmed; in case of digitization, the material part is comprised of either a pre-printed or pre-programmed form or the reconstitution in paper form of the digitized form and particulars in the statement of offence.
The same is true of the return document or the other additional documents bearing the defendant’s response.
O.C. 1211-97, s. 19.
20. A prosecutor wishing to adduce as evidence a hard-copy statement of offence may submit only the hard-copy of the front of the pages or of the computer data in the corresponding page screens in the statement. However, the prosecutor shall, if need be, make the back of the pages or the data in the corresponding page screens of the statement of offence available to the judicial authority either in paper form or in electronic form.
O.C. 1211-97, s. 20.
21. The hard-copy statement of offence intended for the defendant shall be generated in accordance with the first and third paragraphs of section 15, whether it is converted into hard copy on a pre-printed or on a pre-programmed statement of offence form.
The hard-copy statement of offence intended for the prosecutor or for the judicial authority may be generated on pages not less than 9 cm wide by 20 cm high nor more than 21.5 cm wide by 35.5 cm high.
O.C. 1211-97, s. 21.
22. The paper used to convert into hard copy the statement of offence intended for the defendant, the statement of offence intended for the judicial authority to be kept in the court record or the statement of offence intended for the prosecutor to be used as documentary evidence shall be such that the statement can be recognized as an original, either by use of paper of a special grain, or by means of a seal, an acronym, a code, a number, a mark or a distinctive indication.
The type size of the printer or the printing press, as the case may be, used to convert the statement of offence into hard copy shall be no smaller than 6 point.
O.C. 1211-97, s. 22.
CHAPTER II
SPECIAL PROVISIONS
DIVISION I
TYPES OF STATEMENTS OF OFFENCE
23. Four types of statement of offence may be used for proceedings in respect of offences against the provisions of statutes and regulations enacted or made in Québec:
(1)  a general statement of offence with a request for sentence allowing for a greater sentence than the minimum sentence, a model for which appears in Schedule I, applies to all offences, except offences to which Division II of Chapter VI of the Code of Penal Procedure (chapter C-25.1) applies, and allows a request for a greater sentence than the minimum sentence; it is intended to be remitted at the time of the offence or following a summary investigation, where the prosecutor requests a greater sentence than the minimum sentence, or to be served after an offence is committed, where a detailed investigation or special inquiry is required in respect of the offence or the sentence;
(2)  a general statement of offence with a request for sentence for the minimum sentence, a model for which appears in Schedule II, applies to all offences, except offences to which Division II of Chapter VI of the Code of Penal Procedure applies, and allows only a request for the minimum sentence; it is intended to be remitted at the time of the offence or to be served following a summary investigation;
(3)  a statement of offence issued for an offence relating to the control of highway transportation, highway safety or parking violations or for an offence which a municipality is responsible for prosecuting, whether or not Division II of Chapter VI of the Code of Penal Procedure applies to those offences, a model for which appears in Schedule III, is intended to be remitted at the time of the offence or to be served following the offence, in cases where the prosecutor requests the minimum sentence only; and
(4)  a statement of offence issued for a parking violation, whether or not Division II of Chapter VI of the Code of Penal Procedure applies to the offence, a model for which appears in Schedule IV, is intended to be remitted at the time of the offence or following it, in cases where the prosecutor requests the minimum sentence only.
A statement of offence converted into hard copy within the meaning of Division V of Chapter I of this Regulation must include an attestation of hard copy conversion. A model for the front and back of the type of statement of offence provided for in subparagraph 3 of the first paragraph bearing an attestation of hard copy conversion is set out in Schedule V.
O.C. 1211-97, s. 23; O.C. 633-2006, s. 1.
DIVISION II
GENERAL STATEMENT OF OFFENCE WITH A REQUEST FOR SENTENCE ALLOWING FOR A GREATER SENTENCE THAN THE MINIMUM SENTENCE
24. The front of the pages or the data on the corresponding page screens in the general statement of offence with a request for sentence allowing for a greater sentence than the minimum sentence shall contain the hearings, key words, texts and spaces allowing all the following particulars to be entered:
(1)  the title “Statement of Offence” and the number of the statement of offence;
(2)  the judicial district in which the proceedings are instituted;
(3)  if the statement of offence is in paper form, the court office record number; if the statement of offence is in electronic form, that number may be entered in another document electronically attached or referenced to the statement of offence;
(4)  the prosecutor’s name and address; the prosecutor’s address may appear on the back of the statement of offence rather than on the front;
(5)  the defendant’s name and address;
(6)  a description of the offence and the minimum sentence prescribed for a first offence against the legislative provision violated;
(7)  the name, quality and signature of the issuer of the statement of offence or, as the case may be, his signature affixed electronically or the validation code for his signature so affixed, and the date on which the statement is issued;
(8)  the date and time of service of the statement of offence by a bailiff or a peace officer or, for service by mail, the reference to the document stating that date;
(9)  if the statement of offence is served other than by mail, the name, quality and signature of the person who served the statement of offence or, as the case may be, his signature affixed electronically or the validation code for his signature so affixed;
(10)  a request for sentence stating the sentence, the costs and, where applicable, the amount of the contribution provided for in article 8.1 of the Code of Penal Procedure (chapter C-25.1) and, where the prosecutor requests a greater sentence than the minimum sentence, the sentence requested and the reasons for the request;
(11)  the defendant’s plea and, in the case of a plea of guilty, mention of the fact that the greater sentence requested may be contested;
(12)  the defendant’s signature or, as the case may be, his signature affixed electronically or the validation code for his signature so affixed, the quality of the signatory if the defendant is a legal person, and the date of the signature; and
(13)  a notice or an order relating to the offence described and provided for in the statute creating the offence.
O.C. 1211-97, s. 24; O.C. 973-2003, s. 3; O.C. 633-2006, s. 2.
25. The front of the pages or the data on the corresponding page screens in the statement of offence may also contain the following particulars:
(1)  the prosecutor’s file number;
(2)  the defendant’s birthdate;
(3)  the type of document or file and the items in the document or file that make it possible to confirm the defendant’s identity;
(4)  space to indicate a change of address;
(5)  in the section concerning the conversion of the statement into hard copy:
(a)  an attestation of hard-copy conversion;
(b)  the name and quality of the person attesting to the hard-copy conversion and the date and exact time of conversion; and
(c)  the signature of the person attesting to the hard-copy conversion or, as the case may be, his signature affixed electronically or the validation code for his signature so affixed;
(6)  the computer codes, marks or particulars making it possible to locate the documents electronically attached or referenced to the statement of offence; and
(7)  the computer codes, marks or particulars making it possible to ensure the security of the data contained in the statement of offence.
O.C. 1211-97, s. 25.
26. The statement of offence in paper form intended for the defendant shall consist of a stub and a detachable portion. Where the statement is in electronic form, the detachable portion may be transmitted electronically, displayed or converted into hard copy separately, and it shall contain the particulars prescribed in paragraphs 11 and 12 of section 24 and, where applicable, an attestation of hard-copy conversion complying with that prescribed in paragraph 5 of section 25 and the number of the statement of offence from which that part was converted.
O.C. 1211-97, s. 26.
27. The statement of offence in paper form intended for the judicial authority shall also consist of a stub and a detachable portion. Where the statement is in electronic form, the detachable portion may be transmitted electronically, displayed or converted into hard copy separately, and it shall contain the particulars prescribed in paragraphs 10, 11 and 12 of section 24 and, where applicable, an attestation of hard-copy conversion and the number of the statement of offence from which that part was converted.
The particulars in paper form prescribed in paragraphs 11 and 12 of section 24 may be replaced in the detachable portion by a statement of offence service report, which shall also be detachable. Where that portion is in electronic form, it may be transmitted electronically, displayed or converted into hard copy separately. In such case, the number of the statement of offence shall be entered in the part of the statement of offence concerning the request for sentence and in the part of the statement of offence concerning the service report and, where applicable, the hard-copy portion of the statement of offence shall contain an attestation of hard-copy conversion.
O.C. 1211-97, s. 27.
28. The back of the pages or the data on the corresponding page screens in the statement of offence shall contain at least the headings, key words, texts and spaces allowing the following to be entered:
(1)  a description of the general purpose of a statement of offence;
(2)  a description of the procedural steps entailed either by transmitting or failing to transmit a plea or by indicating an intent to contest the greater sentence requested;
(3)  the place where the defendant must transmit the plea and, in the case of a plea of guilty, the place where he must transmit the total amount of the fine, the costs and, where applicable, the contribution, or the notice of his intent to contest the greater sentence requested;
(4)  the deadline by which the defendant must transmit the plea and, in the case of a plea of guilty, the deadline by which he must transmit the total amount of the fine, the costs and, where applicable, the contribution, or the notice of his intent to contest the greater sentence requested;
(5)  the procedure for payment of the total amount of the fine, the costs and, where applicable, the contribution;
(6)  mention of the fact that preliminary applications may be made; and
(7)  the right to counsel.
The back of the pages or the data on the corresponding page screens in the statement of offence shall indicate the place or the telephone number at which the defendant may obtain additional information concerning the statement of offence.
The back of the pages may also contain a section for explanation of the codes and acronyms and, depending on the type of payment required in the request for sentence, may contain one or more of the following:
(1)  a box where a cashier’s stamp may be affixed attesting that a payment has been received;
(2)  a payment receipt form;
(3)  a record or an attestation of an electronic transaction; and
(4)  the reference to the document attesting to the receipt of a payment.
O.C. 1211-97, s. 28; O.C. 973-2003, s. 4.
DIVISION III
GENERAL STATEMENT OF OFFENCE WITH A REQUEST FOR THE MINIMUM SENTENCE
29. The front of the pages or the data on the corresponding page screens in the general statement of offence with a request for the minimum sentence shall contain the headings, key words, pre-printed or pre-programmed texts and spaces allowing the following particulars to be entered:
(1)  in the page header:
(a)  the title “Statement of Offence” and the number of the statement of offence;
(b)  the judicial district in which the proceedings are instituted;
(c)  if the statement of offence is in paper form, the court office record number; if the statement of offence is in electronic form, that number may be entered in another document electronically attached or referenced to the statement of offence; and
(d)  the prosecutor’s name and address; the prosecutor’s address may appear on the back of the statement of offence rather than on the front;
(2)  in the section concerning identification of the defendant, his or its name and address and the following optional particulars:
(a)  mention of whether the defendant is a legal or natural person and, in the latter case, whether male or female;
(b)  the defendant’s birthdate; and
(c)  the type of document or file and the items in the document or file making it possible to confirm the defendant’s identity, and the province or state of origin of the document or file;
(3)  in the section concerning the offence:
(a)  the reference to the legislative provisions creating the offence alleged to have been committed;
(b)  a description of the offence;
(c)  the date on which the offence was committed; and
(d)  the time at which the offence was committed, if relevant to the charge;
(4)  in the section concerning the place where the offence was committed:
(a)  the place where the offence is alleged to have been committed; and
(b)  the location code of that place, if relevant to the charge;
(5)  in the section concerning the sentence:
(a)  the amount of the minimum sentence, the minimum costs prescribed by law for the offence and, where applicable, the contribution; and
(b)  the total amount of the fine, the costs and, where applicable, the contribution requested by the prosecutor;
(6)  in the section concerning the attestation of the facts and service of the statement of offence:
(a)  the attestation of the facts by the person who issued the statement of offence;
(b)  the name and quality of the person attesting to the facts and, if the person is a peace officer, his number;
(c)  mention of the fact that that person did not serve the statement of offence;
(d)  mention of the fact that service is made at the time the offence was committed or following it;
(e)  how service was made;
(f)  the name and quality of the person serving the statement of offence or mention of the fact that he is the same person as the person attesting to the facts;
(g)  the date and time of service or the reference to the document indicating the date and time of service; and
(h)  the signature of the person attesting to the facts and of the person serving the statement of offence or, as the case may be, their respective signatures affixed electronically or the validation codes for their signatures so affixed; where the attestation and service are made by the same person, mention of that fact and that person’s signature for the attestation of the facts and for service or, as the case may be, his signature affixed electronically or the validation code for his signature so affixed;
(7)  in the section concerning the conversion of the statement of offence into hard copy, the particulars prescribed in paragraph 5 of section 25;
(8)  the computer codes, marks or particulars making it possible to locate the documents electronically attached or referenced to the statement of offence; and
(9)  the computer codes, marks or particulars making it possible to ensure the security of the data contained in the statement of offence.
O.C. 1211-97, s. 29; O.C. 973-2003, s. 5; O.C. 633-2006, s. 3.
30. The back of the pages or the data on the corresponding page screens in the statement of offence shall contain at least the headings, key words, texts and spaces allowing the particulars prescribed in section 28 to be entered, except for the particulars concerning the request for a greater sentence than the minimum sentence prescribed in subparagraphs 2, 3 and 4 of the first paragraph of that section.
O.C. 1211-97, s. 30.
31. The front of the pages or the data on the corresponding page screens of the return document in the statement of offence shall contain the headings, key words, pre-printed or pre-programmed texts and spaces allowing the following particulars to be entered:
(1)  the number of the statement of offence;
(2)  the defendant’s plea;
(3)  the defendant’s signature or, as the case may be, his signature affixed electronically or the validation code for his signature so affixed, and the date of the signature;
(4)  the sentence indicating the minimum sentence and costs prescribed by law and, where applicable, the contribution, and the total amount of the fine, the costs and, where applicable, the contribution;
(5)  the place where the defendant must transmit the plea and, in the case of a plea of guilty, the place where he must transmit the total amount of the fine, the costs and, where applicable, the contribution;
(6)  the deadline by which the defendant must transmit the plea and, in the case of a plea of guilty, the deadline by which he must transmit the total amount of the fine, the costs and, where applicable, the contribution;
(7)  the date of service of the statement of offence; and
(8)  the sum actually paid.
O.C. 1211-97, s. 31; O.C. 973-2003, s. 6.
32. The back of the pages or the data on the corresponding page screens of the return document in the statement of offence may, depending on the type of payment required, contain one or more of the following:
(1)  a box where a cashier’s stamp may be affixed attesting to the receipt of a payment;
(2)  a payment receipt form;
(3)  a record or an attestation of an electronic transaction; and
(4)  the reference to the document attesting to the receipt of a payment.
O.C. 1211-97, s. 32.
DIVISION IV
STATEMENT OF OFFENCE ISSUED FOR AN OFFENCE RELATING TO THE CONTROL OF HIGHWAY TRANSPORTATION, HIGHWAY SAFETY OR PARKING VIOLATIONS OR FOR AN OFFENCE WHICH A MUNICIPALITY IS RESPONSIBLE FOR PROSECUTING
33. (Revoked).
O.C. 1211-97, s. 33; O.C. 140-2000, s. 1; O.C. 973-2003, s. 7; O.C. 633-2006, s. 4.
34. The front of the pages or the data on the corresponding page screens in the statement of offence issued for an offence relating to the control of highway transportation, highway safety or parking violations or for an offence which a municipality is responsible for prosecuting shall contain the headings, key words, texts and spaces allowing the following particulars to be entered:
(1)  in the page header:
(a)  the title “Statement of Offence” and the number of the statement;
(b)  (subparagraph revoked);
(c)  the judicial district in which the proceedings are instituted;
(d)  if the statement of offence is in paper form, the court office record number; if the statement of offence is in electronic form, that number may be entered in another document electronically attached or referenced to the statement of offence; and
(e)  the prosecutor’s name and address; the prosecutor’s address may appear on the back of the statement of offence rather than on the front;
(2)  in the section concerning identification of the defendant, the defendant’s name and address or, if the offence is a parking violation, an indication that the vehicle owner is identified as the defendant, and the following optional particulars:
(a)  his place of residence and whether he is a non-resident or a transport services intermediary;
(b)  mention of whether the defendant is a legal or natural person and, in the latter case, whether male or female;
(c)  his birthdate; and
(d)  the type of document or file and the items in the document or file making it possible to confirm the defendant’s identity, and the province, territory or state of origin of the document or file;
(3)  in the section concerning the vehicle, the registration number or, where applicable, the temporary registration number, and the following optional particulars:
(a)  the year of expiry of the registration or the expiry date of the right to travel and the province or state that issued the registration; and
(b)  the make, model and year of the vehicle, its declared number of axles and its declared net weight;
(4)  in the section concerning the offence:
(a)  the reference to the legislative provisions creating the offence alleged to have been committed;
(b)  a description of the offence;
(c)  the date on which the offence was committed and, if relevant, the time at which it was committed;
(d)  specification of the recorded speed, recorded weight and authorized weight of the vehicle at the size recorded and at the allowed size, speed zone, the means of interception and, where applicable, mention of the fact that the offence is alleged to have been committed during a thaw period; and
(e)  for information purposes, the demerit points corresponding to the alleged offence;
(5)  in the section concerning the place where the offence was committed:
(a)  the place where the offence is alleged to have been committed; and
(b)  specification of the vehicle’s position in relation to that place;
(6)  in the section concerning the driver, his name, if he is not the defendant identified in the section referred to in paragraph 2, and the following optional particulars:
(a)  his birthdate;
(b)  the type of document or file, the items in the document or file making it possible to confirm the driver’s identity and the province, territory or state of origin of the document or file; and
(c)  the name of the operator employing the driver;
(d)  mention of whether the driver is the vehicle operator;
(e)  the reference to the Act respecting owners, operators and drivers of heavy vehicles (chapter P-30.3) for the identification of the penalty that must be considered for the application of that Act;
(7)  in the section concerning the sentence:
(a)  the minimum fine and costs prescribed by law and, where applicable, the amount of the contribution;
(b)  the total amount of the fine, the costs and, where applicable, the contribution requested by the prosecutor; and
(c)  other requests allowed by law;
(8)  in the section concerning the attestation of the facts and the service of the statement of offence, or in separate sections relating to the attestation and service:
(a)  an attestation of the facts by the peace officer or, as the case may be, the person entrusted with the enforcement of the Act who witnessed the offence or issued the statement of offence;
(b)  if applicable, an attestation by the peace officer who issued the statement of offence that the facts constituting the offence were witnessed in part by that peace officer and in part by another peace officer;
(c)  the name and capacity of the person attesting to the facts and badge number if the person is a police officer;
(d)  an attestation that the statement of offence was served at the time of the offence or subsequent to the commission of the offence, or mention of the fact that the duplicate of the statement of offence was not delivered;
(e)  the manner in which service was made;
(f)  the name and capacity of the person who served the statement of offence or mention of the fact that the person who attested to the facts also served the statement of offence;
(g)  the date and time of service or a reference to the document showing the date and time of service; and
(h)  the signature of the person attesting to the facts and of the person serving the statement of offence or, as the case may be, their respective signatures in electronic form or their electronic signature validation codes; if the same person attests to the facts and serves the statement of offence, an indication to that effect and the person’s signature for the attestation of the facts and the service or, as the case may be, the person’s signature in electronic form or the person’s electronic signature validation code;
(8.1)  in a section concerning warnings to the defendant, immediately after the section referred to in paragraph 8, the following boxed text in bold capital letters, in 9-point print or larger:

_____________________________________
| |
| IMPORTANT |
|_____________________________________|
| |
| PLEASE READ WARNING NO. 1 ON THE |
| BACK. HOWEVER, IF YOU ARE UNDER 18 |
| YEARS OF AGE OR IF THIS BOX IS |
| CHECKED □ PLEASE READ WARNING NO. 2 |
| ON THE BACK. |
|_____________________________________|
That section is used by the issuer of the statement of offence to notify the defendant of the default proceedings that apply;
(9)  in the section concerning the conversion of the statement of offence into hard copy, the particulars prescribed in paragraph 5 of section 25; and
(10)  the computer particulars prescribed in paragraphs 6 and 7 of section 25.
O.C. 1211-97, s. 34; O.C. 140-2000, s. 2; O.C. 973-2003, s. 8; O.C. 633-2006, s. 5.
35. The back of the pages in the statement of offence form, or the data on the corresponding page screens, must contain at least the headings, keywords, texts and spaces allowing the following to be entered:
(1)  a description of the general purpose of a statement of offence;
(2)  a description of the procedure that follows the entering of a plea or a failure to enter a plea;
(3)  the address to which the defendant must send the plea and, if the defendant enters a plea of guilty, the address to which the total amount of the fine, costs and, if applicable, contribution, must be sent;
(4)  the time within which the defendant must enter a plea and the time within which the total amount of the fine, costs and, if applicable, contribution, must be paid if the defendant enters a plea of guilty;
(5)  the procedure for payment of the total amount of the fine, costs and, if applicable, contribution;
(6)  the following warnings, under a heading on the failure to enter a plea, in bold capital letters, in 9-point print or larger:
FAILURE TO ENTER A PLEA AND PAY TOTAL AMOUNT OF THE FINE AND COSTS

___________________________________________________
| |
| WARNING NO. 1 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE |
| TOTAL AMOUNT OR A PART OF THE FINE AND COSTS |
| WITHIN 30 DAYS AFTER THE DATE OF SERVICE |
| INDICATED IN THE “SERVICE” SECTION OF THE |
| STATEMENT OF OFFENCE, YOU WILL BE DEEMED |
| NOT TO CONTEST THE PROCEEDINGS AND MAY BE |
| CONVICTED BY DEFAULT (IN YOUR ABSENCE) |
| WITHOUT AN OPPORTUNITY TO BE HEARD. |
|___________________________________________________|

___________________________________________________
| |
| WARNING NO. 2 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE |
| TOTAL AMOUNT OF THE FINE AND COSTS WITHIN |
| 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN |
| THE “SERVICE” SECTION OF THE STATEMENT OF |
| OFFENCE OR IN THE DOCUMENT REFERRED TO, YOU |
| WILL BE DEEMED TO HAVE ENTERED A PLEA OF NOT |
| GUILTY. PROCEEDINGS WILL THEN BE TRIED IN YOUR |
| ABSENCE AND JUDGMENT WILL BE RENDERED WITHOUT |
| FURTHER NOTICE. |
|___________________________________________________|
(7)  general information on demerit points;
(8)  a notice that preliminary applications may be filed with a plea of not guilty; and
(9)  the defendant’s right to seek legal counsel.
The back of the pages in the statement of offence form, or the data on the corresponding page screens, must state the place or the telephone number at which the defendant may obtain additional information concerning the statement of offence.
The back of the pages or the corresponding page screen data may also contain a section for an explanation of codes or initials and, depending on the type of payment, may contain one or more of the following:
(1)  a boxed space where a cashier’s stamp may be affixed attesting that a payment has been received;
(2)  a payment receipt form;
(3)  a record or an attestation of an electronic transaction; and
(4)  reference to the document attesting the receipt of a payment.
The back may also contain a section for the prosecutor’s address, if applicable.
O.C. 1211-97, s. 35; O.C. 633-2006, s. 6.
36. The front of the plea form on the statement of offence, or the data on the corresponding page screens, must consist of 2 sections which contain at least the headings, keywords, pre-printed or pre-programmed texts and spaces allowing the following to be entered:
(1)  in the section concerning the plea:
(a)  the statement of offence number;
(b)  the defendant’s plea; and
(c)  the defendant’s signature or, as the case may be, the defendant’s signature in electronic form or the electronic signature validation code, and the date of signature; and
(2)  in the section concerning the penalty and the payment:
(a)  the minimum fine and costs prescribed by law and, if applicable, the contribution, and the total amount of the fine, costs and, if applicable, contribution;
(b)  other amounts that may be imposed by law;
(c)  the address to which the defendant must send the plea and, if the defendant enters a plea of guilty, the address to which the total amount of the fine, costs and, if applicable, contribution, must be sent;
(d)  a repetition of the date of service of the statement of offence; and
(e)  any amount that has been paid.
O.C. 1211-97, s. 36; O.C. 973-2003, s. 9; O.C. 633-2006, s. 7.
37. The back of the pages or the data on the corresponding page screens of the return document in the statement of offence may, depending on the type of payment required, contain one or more of the following:
(1)  a box where a cashier’s stamp may by affixed attesting that a payment has been received;
(2)  a payment receipt form;
(3)  a record or an attestation of an electronic transaction; and
(4)  the reference to the document attesting to the receipt of a payment.
O.C. 1211-97, s. 37.
DIVISION V
STATEMENT OF OFFENCE ISSUED FOR A PARKING VIOLATION
38. The front of the pages or the data on the corresponding page screens in the statement of offence issued for a parking violation shall contain the headings, key words, texts and spaces allowing the following particulars to be entered:
(1)  in the page header:
(a)  the title “Statement of Offence” and the number of the statement of offence;
(b)  the judicial district in which the proceedings are instituted;
(c)  the prosecutor’s name and address; the prosecutor’s address may appear on the back of the statement of offence rather than on the front; and
(d)  the fact that the vehicle owner will be identified as the defendant, and the defendant’s name and address if known at the time the statement of offence is served;
(2)  in the section concerning the vehicle:
(a)  the vehicle’s registration number or, where applicable, the temporary registration certificate number, the name and address of the holder of the certificate and the province, territory or state that issued the registration;
(b)  the make and model of the vehicle; and
(c)  the place to which the vehicle has been towed, where applicable;
(3)  in the section concerning the time and the place at which the offence was committed:
(a)  the date and time when the offence was committed;
(b)  the place where the offence is alleged to have been committed;
(c)  specification of the vehicle position in relation to that place;
(d)  the parking control sign; and
(e)  the number of the parking meter;
(4)  in the section concerning the offence, a description of the offence;
(5)  in the section concerning the sentence:
(a)  the minimum fine and costs prescribed by law and, where applicable, the amount of the contribution;
(b)  the total amount of the fine, the costs and, where applicable, the contribution requested by the prosecutor; and
(c)  other requests allowed by law;
(6)  in the section concerning the attestation of the facts and the service of the statement of offence, or in separate sections relating to the attestation and service:
(a)  an attestation of the facts by the person who witnessed the offence or issued the statement of offence;
(b)  the name and capacity of the person attesting to the facts and badge number if the person is a police officer;
(c)  an attestation that the statement of offence was served at the time of the offence or subsequent to the commission of the offence, or mention of the fact that the defendant was not given a duplicate of the statement of offence;
(d)  the manner in which service was made;
(e)  the name and capacity of the person who served the statement of offence or mention of the fact that the person who attested to the facts also served the statement of offence;
(f)  the date and time of service or a reference to the document showing the date and time of service; and
(g)  the signature of the person attesting to the facts and of the person serving the statement of offence or, as the case may be, their respective signatures in electronic form or their electronic signature validation codes; if the same person attests to the facts and serves the statement of offence, an indication to that effect and the person’s signature for the attestation of the facts and the service or, as the case may be, the person’s signature in electronic form or the person’s electronic signature validation code;
(6.1)  in a section concerning warnings to the defendant, immediately after the section referred to in paragraph 6, the following boxed text in bold capital letters, in 9-point print or larger:

_____________________________________
| |
| IMPORTANT |
|_____________________________________|
| |
| PLEASE READ WARNING NO. 1 ON THE |
| BACK. HOWEVER, IF YOU ARE UNDER 18 |
| YEARS OF AGE OR IF THIS BOX IS |
| CHECKED □ PLEASE READ WARNING NO. 2 |
| ON THE BACK. |
|_____________________________________|
That section is used by the issuer of the statement of offence to notify the defendant of the default proceedings that apply;
(7)  in the section concerning the conversion of the statement of offence into hard copy, the particulars prescribed in paragraph 5 of section 25; and
(8)  the computer particulars prescribed in paragraphs 6 and 7 of section 25.
O.C. 1211-97, s. 38; O.C. 973-2003, s. 10; O.C. 633-2006, s. 8.
39. The back of the pages in the statement of offence, or the data on the corresponding page screens, must contain at least the headings, keywords, texts and spaces allowing the information set out in section 35 to be entered, except the information in subparagraph 7 of the first paragraph of that section.
O.C. 1211-97, s. 39; O.C. 633-2006, s. 9.
40. The front of the pages or the data on the corresponding page screens of the return document in the statement of offence shall contain the headings, key words, texts and spaces allowing the following particulars to be entered:
(1)  in the page header, the following particulars:
(a)  the number of the statement of offence;
(b)  the name of the judicial district;
(c)  (subparagraph revoked);
(d)  the vehicle’s registration number or, where applicable, the temporary registration certificate number, and the province, territory or state that issued the registration, as well as the make and model of the vehicle;
(e)  the date on which the offence was committed;
(f)  the request for sentence; and
(g)  the date and time of service of the statement of offence; and
(2)  in the section concerning the plea and payment:
(a)  the defendant’s plea of guilty;
(b)  the defendant’s signature or, as the case may be, his signature affixed electronically or the validation code for his signature so affixed, the date of the signature and the quality of the signatory if the defendant is a legal person;
(c)  the place where the defendant must transmit the plea or the place where payment must be made and the deadline by which the plea must be transmitted and the payment made;
(d)  the consequences of paying the total amount of the fine, the costs and, where applicable, the contribution; and
(e)  the sum actually paid.
O.C. 1211-97, s. 40; O.C. 973-2003, s. 11; O.C. 633-2006, s. 10.
41. The back of the pages or the data on the corresponding page screens of the return document in the statement of offence must contain at least the headings, key words, texts and spaces allowing the following particulars to be entered:
(1)  the defendant’s plea of not guilty;
(2)  the defendant’s name, address and signature or, as the case may be, his signature affixed electronically or the validation code for his signature so affixed;
(3)  the date on which the plea is signed;
(4)  the make and model of the vehicle and the vehicle’s registration number;
(5)  the place where the defendant must transmit the plea and the deadline by which he must transmit it to the place indicated;
(6)  (paragraph revoked); and
(7)  depending on the type of payment required, one or more of the following:
(a)  a box where a cashier’s stamp may be affixed attesting that a payment has been received;
(b)  a payment receipt form;
(c)  a record or an attestation of an electronic transaction; and
(d)  the reference to the document attesting to the receipt of a payment.
O.C. 1211-97, s. 41; O.C. 633-2006, s. 11.
CHAPTER III
TRANSITIONAL AND FINAL
42. (Revoked).
O.C. 1211-97, s. 42; O.C. 633-2006, s. 12.
43. This Regulation replaces the Regulation respecting the form of statements of offence (O.C. 1019-93, 93-07-14).
O.C. 1211-97, s. 43.
44. (Omitted).
O.C. 1211-97, s. 44.
SCHEDULE I
(s. 23, 1st par., subpar. 1)
CANADA
PROVINCE OF QUÉBEC STATEMENT OF OFFENCE
Judicial district of
No.
DEFENDANT PROSECUTOR
Record No.:
I have reasonable grounds to believe that the defendant has committed the following offence:
(N.B. The minimum sentence is indicated after the description of the offence.)

c Criminal and penal prosecuting attorney, or Signature Date
c Person authorized by the prosecutor
(Indicate quality)
Date of The following
service of OR when served by: c Bailiff c Peace officer
statement Signature:

REQUEST FOR SENTENCE

Sentence: + Costs: + Contribution: = Total amount
Grounds for a greater sentence than the minimum sentence:
If a greater sentence than the minimum sentence is requested and if the defendant transmits a plea of guilty but contests the greater sentence requested, he is not required to transmit the whole amount of the fine and costs requested.

p Detach here and p
PLEA OF GUILTY return to the address
Identification OR NOT GUILTY indicated on back.
of the prosecutor (See instructions on back)
To the offence described in statement No. ,I, the undersigned, plead:
c Guilty;
c Guilty, but I contest the greater sentence requested;
c No guilty.

Signature of defendant (For legal person, see back) Date Quality
•AC-128A (93-07) If address has changed, indicate new address

When served by mail, the date indicated on the notice of receipt or delivery or the date indicated on the envelope.
Date
Time
STATEMENT OF OFFENCE
Penal proceedings are instituted by means of a statement of offence and commence at the time the statement is served.
TRANSMISSION OF PLEA
You are required to transmit your plea of guilty or not guilty within 30 days following the date on which the statement of offence is served on you by mail, by bailiff, by peace officer or by such other means as may be authorized by a judge.
If the defendant is a legal person, one of its directors or other officers is required to sign. The signatory must indicate his quality.
PLEA OF GUILTY AND PAYMENT
If you plead guilty to the offence alleged, use the detachable portion of the statement of offence to:
· enter your plea, and
· pay the whole amount of the fine, the costs and the contribution.
In accordance with section 8.1 of the Code of Penal Procedure (chapter C-25.1), from each contribution collected, the first $10 shall be credited to the Crime Victims Assistance Fund established under the Act respecting assistance for victims of crime (chapter A-13.2), and the following $8 shall be credited to the Access to Justice Fund established under the Act respecting the Ministère de la Justice (chapter M-19).
The plea and the payment must be transmitted to the address indicated on the back of the detachable portion.
A defendant who pleads guilty must transmit the whole amount requested. If he fails to do so, an additional amount of costs may be required.
Payment may be made in Canadian funds by cheque or postal order made out to the Minister of Finance. Payment in cash is not recommended.
A defendant who transmits the whole amount of the fine and costs requested without entering a plea is deemed to have transmitted a plea of guilty.
If the defendant has transmitted or is deemed to have transmitted a plea of guilty without indicating his intention to contest the sentence requested, he is deemed to have been convicted of the offence.
PLEA OF NOT GUILTY
If you plead not guilty to the offence or guilty with the intention to contest the greater sentence than the minimum sentence requested, use the detachable portion or the statement of offence to:
· enter your plea, and
· return it to the address indicated on the back.
The defendant will receive from the clerk of the court of competent jurisdiction a notice of the place, date and time fixed to try the proceeding or to hear the contestation of the sentence.
FAILURE TO TRANSMIT A PLEA
A defendant who does not transmit a plea or the whole amount of the fine and costs requested is deemed to have transmitted a plea of not guilty, and the proceeding will be tried and judgment rendered without further notice.
PRELIMINARY APPLICATIONS
The provide for your defence, you may make, together with your plea of not guilty, the preliminary applications provided for in articles 168 to 186 of the Code of Penal Procedure.
RIGHT TO COUNSEL
You have right to counsel before transmitting a plea or making a preliminary application.
_________________________________________________________________________________
| |
| Information |
| |
| |
|_________________________________________________________________________________|
Return mailing address for
plea and any payment
O.C. 1211-97, Sch. I; O.C. 973-2003, s. 12; I.N. 2016-01-01.
SCHEDULE II
(s. 23, 1st par., subpar. 2)
STATEMENT OF OFFENCE
Judicial district
Court office: record No.
Prosecutor
A Defendant
1- Mr.
2- Mrs.
3- Legal person
Surname
Given name(s)
Address Apt.
Locality
Province/State Postal code Minor Date of birth (Y-M-D)
Confirmation of identity
B Offence
Statute/Regulation
Section Code
Description of offence
Date of offence (Y-M-D)
Time (H-M)
C Place
Place
Location Zone
D$
Sentence
Minimum sentence Costs Contribution Amount requested
$ + $ + $ = $
E
ATTESTATION
I, the undersigned, attest that I have personally observed the facts mentioned in
c A c B c C
and I have reasonable grounds to believe that the offence described in B has been committed.
Name (In block letters)
Peace officer Officer’s number Unit
Person responsible for enforcement of the law Quality
SERVICE
I remitted c when the offence was committed
c after the offence was committed
c to the defendant c to the driver
c in a conspicuous place on the vehicle
c otherwise:
Name (In block letters) c Same as attestation
Peace officer Officer’s number Unit
Person responsible for enforcement of the law Quality
c I did not remit a duplicate of the statement of offence
c I observed the facts and serviced a duplicate of the statement of offence Date of service Y-M-D Time (H-M)
(only one signature required below)
Signature Signature
*CR-88A (93-07)
DEFENDANT







STATEMENT OF OFFENCE
Penal proceedings are instituted by means of a statement of offence and commence at the time statement is served.
TRANSMISSION OF PLEA
You are required to enter a plea of guilty or not guilty within 30 days following the date of service indicated in the part entitled SERVICE in section E of the statement of offence or in the reference document identified in that same part of Section E.
If the defendant is a legal person, one of its directors or other officers is required to sign. The signatory must indicate his quality.
PLEA OF GUILTY AND PAYMENT
If you plead guilty to the offence alleged, use the return form attached hereto in order to:
· enter you plea, and
· pay (in Canadian funds) the total amount of the fine, the costs and the contribution.
In accordance with section 8.1 of the Code of Penal Procedure (chapter C-25.1), from each contribution collected, the first $10 shall be credited to the Crime Victims Assistance Fund established under the Act respecting assistance for victims of crime (chapter A-13.2), and the following $8 shall be credited to the Access to Justice Fund established under the Act respecting the Ministère de la Justice (chapter M-19).
The plea and the payment may be transmitted to the address indicated on the return form or to ..........
Payment may be made by cheque or postal order made out to ..........
Unless the total amount of the fine, the costs and the contribution is transmitted together with this plea, additional costs may be imposed.
If the defendant transmits a plea of guilty, he is deemed to have been convicted of the offence.
PLEA OF NOT GUILTY
If you plead not guilty to the offence, enter your plea on the return form attached hereto. Your plea must be transmitted to the address indicated on the return form.
You will be notified by the clerk of the court of competent jurisdiction of the place, date and time fixed for trial of the proceeding.
FAILURE TO TRANSMIT A PLEA AND THE AMOUNT OF THE FINE AND COSTS
A defendant who does not transmit a plea or the whole amount of the fine and costs requested is deemed to have transmitted a plea of not guilty. In such a case, the proceeding will be tried and judgment rendered without further notice.
PRELIMINARY APPLICATIONS
To provide for your defence, you may make, together with your plea of not guilty, the preliminary applications provided for in articles 168 to 186 of the Code of Penal Procedure.
RIGHT TO COUNSEL
You have a right to counsel before transmitting a plea or making a preliminary application.
_________________________________________________________________________________
| |
| Information |
| |
| |
|_________________________________________________________________________________|
DEFENDANT
RETURN FORM

PLEA

IMPORTANT: CONCERNING THE CONSEQUENCES OF THIS PLEA, SEE BACK OF THE STATEMENT OF OFFENCE

TO THE INFRACTION DESCRIBED IN PART B OF THE STATEMENT OF OFFENCE

No. , I PLEAD:

c Guilty c Not guilty
(If you wish to provide explanations, write them below)






Signature Date Y-M-D

If address has changed indicate new address

Postal code

RETURN MAILING ADDRESS FOR PLEA AND ANY PAYMENT

REQUEST FOR SENTENCE
Minimum sentence Costs Contribution Amount requested
$+ $+ $= $

Sum paid $

Date de signature
Y M D

CASHIER’S STAMP
___________________________
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
|___________________________|
O.C. 1211-97, Sch. II; O.C. 973-2003, s. 13; I.N. 2016-01-01.
SCHEDULE III
(s. 23, 1st par., subpar. 3)
000000 0000000000
STATEMENT OF OFFENCE
Judicial district
Court office record number
Prosecutor
A DEFENDANT
1. Mr.
2. Ms.
3. Legal person
4. Owner to be identified c
Surname Given name
Address Apt.
Locality Prov/State Postal code
Confirmation of identity Prov/State c Non resident
c Under 18 years of age
B VEH
Licence plate No. c Temporary registration Certificate Expiry Prov/State Vehicle make
Model Year Number of axles declared Net weight declared
C OFFENCE
c Highway Safety Code
c Municipal traffic or parking by-law
c Other law or regulation
Title of the law or regulation:
Section or article Code Defendant code Vehicle code
DESCRIPTION OF THE OFFENCE
Speed recorded km/h
Speed limit km/h
By 1. Radar
c 2. Vehicle
3. Air
Weight/dimension recorded c kg
c m
Allowable weight/dimension c kg
c m
Date of offence (Y-M-D)
Time from_____ to ____
Demerit points
Thaw period c
D PLACE
Location
Route
Direction
Location
Unit
1- Facing
2- Near
3- Opposite
4- Inters.
5- Rear c
Side
1- North
2- South
3- East
4- West c
E
1- Driver
2- Operator
3- Driver = Operator c
Surname Given name
Confirmation of identity Prov/State O.O.H.V c
F
PENALTY
minimum plea Cost Contribution Total amount
$ + $ + $ = $
G ATTESTATION/SERVICE
ATTESTATION
I, the undersigned, certify that I personalty witnessed the facts set out in
c A c B c C c D c E,
and (if applicable)
certify that ___________________________________, peace officer, badge number ____________________, witnessed the facts set out in
c A c B c C c D c E
and I have reasonable grounds to believe that the offence described in C has been committed.
c I did not deliver a duplicate of the statement of offence.
Name (in block letters)
c Peace officer Badge number Unit
c Person entrusted with the enforcement of the Act Capacity
Signature
SERVICE
I certify that I delivered a duplicate of the statement of offence
c at the time of offence
c subsequent to the commission of the offence
c to the defendant c to the driver
c by leaving it in a conspicuous place on the vehicle
c in another manner (specify):
Name (in block letters) c same as attestation
c Peace officer Badge number Unit
c Person entrusted with the enforcement of the Act Capacity
Time (H-M)
Date of service (Y-M-D)
Signature
H
IMPORTANT
PLEASE READ WARNING NO. 1 ON THE BACK.
HOWEVER, IF YOU ARE UNDER 18 YEARS OF AGE OR IF THIS BOX IS CHECKED c
PLEASE READ WARNING NO. 2 ON THE BACK.



















STATEMENT OF OFFENCE
Penal proceedings are instituted by means of a statement of offence and commence on the date of service of the statement of offence.
PLEA
You are required to enter a plea of guilty or not guilty within 30 days after the date of service indicated in the “SERVICE” section of the statement of offence.
If the defendant is a legal person, a director or officer of the defendant must sign the plea and indicate his or her capacity.
PLEA OF GUILTY AND PAYMENT
If you plead guilty to the offence, please use the attached plea form to:
- enter your plea; and
- pay (in Canadian funds) the total amount of the fine, costs and contribution indicated on the statement of offence.
In accordance with section 8.1 of the Code of Penal Procedure (chapter C-25.1), from each contribution collected, the first $10 shall be credited to the Crime Victims Assistance Fund established under the Act respecting assistance for victims of crime (chapter A-13.2), and the following $8 shall be credited to the Access to Justice Fund established under the Act respecting the Ministère de la Justice (chapter M-19).
The plea and the payment may be sent to the address indicated on the plea form or ..........
Payment may be made (indicate method of payment).
A defendant who enters a plea of guilty is deemed to have been convicted of the offence.
Additional costs may be imposed if the total amount of the fine, costs and contribution is not transmitted with the plea of guilty.
PLEA OF NOT GUILTY
If you plead not guilty to the offence, please enter your plea on the attached plea form. Your plea must be sent to the address indicated on the plea form.
You will be notified by the clerk of the competent court of the place, date and time set for the trial.
PRELIMINARY APPLICATIONS
To prepare your defence, you may file with your plea of not guilty a preliminary application as provided in articles 168 to 186 of the Code of Penal Procedure.
FAILURE TO ENTER A PLEA AND PAY THE TOTAL AMOUNT OF THE FINE AND COSTS
__________________________________________________________________________________
| |
| WARNING NO. 1 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OR A PART OF THE FINE |
| AND COSTS WITNIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” |
| SECTION OF THE STATEMENT OF OFFENCE, YOU WILL BE DEEMED NOT TO CONTEST THE |
| PROCEEDINGS AND MAY BE CONVICTED BY DEFAULT (IN YOUR ABSENCE) WITHOUT AN |
| OPPORTUNITY TO BE HEARD. |
|__________________________________________________________________________________|

__________________________________________________________________________________
| |
| WARNING NO. 2 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OF THE FINE AND COSTS |
| WITHIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” SECTION OF |
| THE STATEMENT OF OFFENCE OR IN THE DOCUMENT REFERRED TO, YOU WILL BE DEEMED TO |
| HAVE ENTERED A PLEA OF NOT GUILTY. PROCEEDINGS WILL THEN BE TRIED IN YOUR |
| ABSENCE AND JUDGMENT WILL BE RENDERED WITHOUT FURTHER NOTICE. |
|__________________________________________________________________________________|
IF YOU ARE CONVICTED BY DEFAULT, ADDITIONAL COSTS MAY BE IMPOSED..
DEMERIT POINTS
The demerit points entered on the statement of offence serve only as a guideline. The Société de l’assurance automobile du Québec is responsible for registering demerit points in a defendant’s record.
RIGHT TO LEGAL COUNSEL
You have the right to seek legal counsel before entering a plea or making a preliminary application.
__________________________________________________________________________________
| |
| INFORMATION |
| |
| |
| |
| PROSECUTOR’S ADDRESS (IF APPLICABLE) |
|__________________________________________________________________________________|
DEFENDANT
PLEA FORM

PLEA
IMPORTANT: SEE THE BACK OF THE STATEMENT OF OFFENCE FOR INFORMATION ON THE CONSEQUENCES OF YOUR PLEA

TO THE OFFENCE DESCRIBED IN SECTION C OF STATEMENT

NO ________________________________, I PLEAD:
c GUILTY c NOT GUILTY

Signature__________________________________________________ Date ________________________________

Please enter any change of address _____________________________________________________________________

____________________________________________________________________________________POSTAL CODE

Address where plea and (if applicable) payment must be sent

NOTICE OF PENALTY

Minimum fine Costs Contribution Total amount
$ + $ + $ = $

Amount paid $

Date de signification Y-M-D


CASHIER’S STAMP
___________________________
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| |
| |
| |
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|___________________________|
O.C. 1211-97, Sch. III; O.C. 140-2000, ss. 3 and 5; O.C. 973-2003, s. 14; O.C. 633-2006, ss. 13, 14 and 15; I.N. 2016-01-01.
SCHEDULE IV
(s. 23, 1st par., subpar. 4)
000000 0000000000
CANADA
PROVINCE OF QUÉBEC

STATEMENT OF OFFENCE
(PARKING)

Judicial district
Prosecutor
Vehicle owner
Defendant
PAYMENT: SEE PLEA
FORM

VEHICLE
Licence plate number Prov/State Vehicle make Model
Temporary registration certificate Towing/Vehicle towed to
Surname Given name
Address Apt.
Town/City Province/State Postal code
Time of the offence Date of offence (Y-M-D)
From To

PLACE
District Parking sign Parking meter number
Location
Highway/Road Direction Location Unit
1- Facing
2- Near
3- Opposite
4- Inters.
5- Rear
Side
1- North
2- South
3- East
4- West

DESCRIPTION OF THE OFFENCE
$
PENALTY
Minimum fine Costs Contribution Total amount
$ + $ + $ = $
c If this box is checked, towing fees of $ __________________have been added.

ATTESTATION/SERVICE
ATTESTATION
I, the undersigned, certify that I personally witnessed the facts set out in this statement of offence and have reasonable grounds to believe that the above-described offence has been committed.
Name (in block letters)
Person entrusted with the enforcement of the Act Capacity
c I did not deliver the duplicate of the statement
c I witnessed the facts and served the duplicate of the statement (only one signature required)
Signature

SERVICE
I certify that I delivered a duplicate of the statement of offence
c at the time of the offence
c subsequent to the commission of the offence
c by leaving it in a conspicuous place on the vehicle
c in another manner (specify):
Name (in block letters) c same as attestation
Person entrusted with the enforcement of the Act Capacity
Date of service (Y-M-D) Time (H-M)
Signature

IMPORTANT
PLEASE READ WARGNING NO. 1 ON THE BACK.
HOWEVER, IF YOU ARE UNDER 18 YEARS OF AGE OR IF THIS BOX IS CHECKED c
PLEASE READ WARNING NO. 2 ON THE BACK.
DEFENDANT
STATEMENT OF OFFENCE
Penal proceedings are instituted by means of a statement of offence and commence on the date of service of the statement of offence.
PLEA
You are required to enter a plea of guilty or not guilty within 30 days after the date of service indicated in the “SERVICE” section of the statement of offence.
If the defendant is a legal person, a director or officer of the defendant must sign the plea and indicate his or her capacity.
PLEA OF GUILTY AND PAYMENT
If you plead guilty to the offence charged, please use the attached plea form to:
- enter your plea, and
- pay (in Canadian funds) the total amount of the fine, costs and contribution indicated on the statement of offence.
In accordance with section 8.1 of the Code of Penal Procedure (chapter C-25.1), from each contribution collected, the first $10 shall be credited to the Crime Victims Assistance Fund established under the Act respecting assistance for victims of crime (chapter A-13.2), and the following $8 shall be credited to the Access to Justice Fund established under the Act respecting the Ministère de la Justice (chapter M-19).
The plea and the payment may be send to the address indicated on the plea form or ..........
Payment may be made (indicate method of payment).
A defendant who enters a plea of guilty is deemed to have been convicted of the offence.
Additional costs may be imposed if the total amount of the fine, costs and contribution is not transmitted with the plea of guilty.
PLEA OF NOT GUILTY
If you plead not guilty to the offence, please enter your plea on the back of the attached plea form. Your plea must be sent to the address indicate on the plea form.
You will be notified by the clerk of the competent court of the place, date and time set for the trial.
PRELIMINARY APPLICATIONS
To prepare your defence, you may file with your plea of not guilty a preliminary application as provided in articles 168 to 186 of the Code of Penal Procedure.
FAILURE TO ENTER A PLEA AND PAY THE TOTAL AMOUNT OF THE FINE AND COSTS
__________________________________________________________________________________
| |
| WARNING NO. 1 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OR A PART OF THE FINE |
| AND COSTS WITNIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” |
| SECTION OF THE STATEMENT OF OFFENCE, YOU WILL BE DEEMED NOT TO CONTEST THE |
| PROCEEDINGS AND MAY BE CONVICTED BY DEFAULT (IN YOUR ABSENCE) WITHOUT AN |
| OPPORTUNITY TO BE HEARD. |
|__________________________________________________________________________________|

__________________________________________________________________________________
| |
| WARNING NO. 2 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OF THE FINE AND COSTS |
| WITHIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” SECTION OF |
| THE STATEMENT OF OFFENCE OR IN THE DOCUMENT REFERRED TO, YOU WILL BE DEEMED TO |
| HAVE ENTERED A PLEA OF NOT GUILTY. PROCEEDINGS WILL THEN BE TRIED IN YOUR |
| ABSENCE AND JUDGMENT WILL BE RENDERED WITHOUT FURTHER NOTICE. |
|__________________________________________________________________________________|
IF YOU ARE CONVICTED BY DEFAULT, ADDITIONAL COSTS MAY BE IMPOSED..
RIGHT TO LEGAL COUNSEL
You have the right to seek legal counsel before entering a plea or making a preliminary application.
__________________________________________________________________________________
| |
| INFORMATION |
| |
| |
| |
| PROSECUTOR’S ADDRESS (IF APPLICABLE) |
|__________________________________________________________________________________|
DEFENDANT
CANADA
PROVINCE OF QUÉBEC
PLEA FORM
Judicial district
Licence plate number Province/State Vehicle make Model

Date of offence (Y-M-D)
PLEA OF GUILTY
c I plead guilty Signature:
Capacity (title) Date
PAYMENT
If you plead guilty to the offence charged, you must pay the Total Amount indicated, or your may be required to pay and additional amount as costs.

Your plea and your payment must be sent no later than 30 days after the date of service appearing at the bottom of this form or, if service was made by mail, the date on the notice of receipt or delivery or on the envelope.

Your plea and payment must be sent to:

RETURN THIS FORM WITH YOUR PAYMENT
$
PENALTY
Minimum fine Costs Contribution Total amount
$ + $ + $ = $
c If this box is checked, towing fees of $ __________________have been added.
AMOUT PAID
$

Date of service (Y-M-D) Time (H-M)

PLEA OF NOT GUILTY
To enter a plea of not guilty, you must complete this form.
c I plead not guilty Signature:
Surname (in block letters) Given name
No. and street Apt.
Town/City
Province Postal code Date (Y-M-D)
Licence plate number Province/State Vehicle make Model

If this statement of offence is maintained, you will be notified by the clerk of the competent courts of the place, date and time set for the trial of the proceedings.

This plea of not guilty must be sent to the following address, no later than 30 days after the date of service:

Address where plea form must be sent

CASHIER’S STAMP
O.C. 1211-97, Sch. IV; O.C. 140-2000, s. 5; O.C. 973-2003, s. 15; O.C. 633-2006, ss. 13, 14 and 15; I.N. 2016-01-01.
SCHEDULE V
(s. 23, 2nd par.)
000000 0000000000
STATEMENT OF OFFENCE
Judicial district
Court office record number
Prosecutor

A DEFENDANT
1. Mr.
2. Ms.
3. Legal person
4. Owner to be identified c
Surname Given name
Address Apt.
Locality Prov/State Postal code
Confirmation of identity Prov/State c Non resident
c Under 18 years of age

B VEH
Licence plate No. certificate c Temporary registration Expiry Prov/State Vehicle make
Model Year No. of axles declared Net weight declared

C OFFENCE
c Highway Safety Code
c Municipal traffic or parking by-law
c Other law or regulation
Title of the law or regulation
Section or article Code Defendant code Vehicle code
DESCRIPTION OF THE OFFENCE
Speed recorded km/h
Speed limit km/h
By c 1. Radar
2. Vehicle
3. Air
Weigh/dimension recorded c kg
c m
Allowable weight/dimension c kg
c m
Date of offence (Y-M-D)
Time from ____________ to ____________
Demerit points
Thaw period c

D PLACE
Location
Highway/Road
Direction
Location
Unit
1. Facing Side
2. Near 1- North
3. Opposite 2- South
4. Inters. 3- East
5. Rear c 4- West c
E
1- Driver
2- Operator
3- Driver = Operator c
Surname Given name
Confirmation of identity Prov/State O.O.H.V. c

F
PENALTY Minimum fine Costs Contribution Total amount
$ + $ + $ = $

G ATTESTATION/SERVICE
ATTESTATION
I, the undersigned, certify that I personally witnessed the facts set out in
c A c B c C c D c E,
and (if applicable)
certify that _________________________, peace officer, badge number _______________________witnessed the facts set out in
c A c B c C c D c E
and I have reasonable grounds to believe that the offence described in C was committed.

c I did not deliver a duplicate of the statement
Name (in block letters))
c Peace officer Badge number Unit
c Person entrusted with the enforcement of the Act Capacity
Signature or validation code

SERVICE
I certify that I delivered a duplicate of the statement of offence:
c at the time of the offence
c subsequent to the commission of the offence
c to the defendant c to the driver
c by leaving it an a conspicuous place on the vehicle
c in another manner (specify)
Name (in block letters) c same as attestation
c Peace officer Badge number Unit
c Person entrusted with the enforcement of the Act Capacity
Time (H-M) Date of service (Y-M-D)
Signature or validation code

H IMPORTANT
PLEASE READ WARNING NO. 1 ONTHE BACK.
HOWEVER, IF YOU ARE UNDER 18 YEARS OF AGE OR IF THIS BOX IS CHECKED c.
PLEASE READ WARING NO. 2 ON THE BACK.

HARD-COPY CONVERSION
I CERTIFY THAT THIS DOCUMENT IS TRUE TO ITS DUPLICATE IN ELECTRONIC FORM.
Date (Y-M-D)
Time (H-M-S)
Authorized person
Name
Capacity
Validation code
STATEMENT OF OFFENCE
Penal proceedings are instituted by means of a statement of offence and commence on the date of service of the statement of offence.
PLEA
You are required to enter a plea of guilty or not guilty within 30 days after the date of service indicated in the “SERVICE” section of the statement of offence.
If the defendant is a legal person, a director or officer of the defendant must sign the plea and indicate his or her capacity.
PLEA OF GUILTY AND PAYMENT
If you plead guilty to the offence charged, please use the attached plea form to:
- enter your plea, and
- pay (in Canadian funds) the total amount of the fine, costs and contribution indicated on the statement of offence.
In accordance with section 8.1 of the Code of Penal Procedure (chapter C-25.1), from each contribution collected, the first $10 shall be credited to the Crime Victims Assistance Fund established under the Act respecting assistance for victims of crime (chapter A-13.2), and the following $8 shall be credited to the Access to Justice Fund established under the Act respecting the Ministère de la Justice (chapter M-19).
The plea and the payment may be send to the address indicated on the plea form or ..........
Payment may be made (indicate method of payment).
A defendant who enters a plea of guilty is deemed to have been convicted of the offence.
Additional costs may be imposed if the total amount of the fine, costs and contribution is not transmitted with the plea of guilty.
PLEA OF NOT GUILTY
If you plead not guilty to the offence, please enter your plea on the attached plea form. Your plea must be sent to the address indicated on the plea form.
You will be notified by the clerk of the competent court of the place, date and time set for the trial.
PRELIMINARY APPLICATIONS
To prepare your defence, you may file with your plea of not guilty a preliminary application as provided in articles 168 to 186 of the Code of Penal Procedure.
FAILURE TO ENTER A PLEA AND PAY THE TOTAL AMOUNT OF THE FINE AND COSTS
__________________________________________________________________________________
| |
| WARNING NO. 1 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OR A PART OF THE FINE |
| AND COSTS WITNIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” |
| SECTION OF THE STATEMENT OF OFFENCE, YOU WILL BE DEEMED NOT TO CONTEST THE |
| PROCEEDINGS AND MAY BE CONVICTED BY DEFAULT (IN YOUR ABSENCE) WITHOUT AN |
| OPPORTUNITY TO BE HEARD. |
|__________________________________________________________________________________|

__________________________________________________________________________________
| |
| WARNING NO. 2 |
| |
| IF YOU DO NOT ENTER A PLEA OR DO NOT PAY THE TOTAL AMOUNT OF THE FINE AND COSTS |
| WITHIN 30 DAYS AFTER THE DATE OF SERVICE INDICATED IN THE “SERVICE” SECTION OF |
| THE STATEMENT OF OFFENCE OR IN THE DOCUMENT REFERRED TO, YOU WILL BE DEEMED TO |
| HAVE ENTERED A PLEA OF NOT GUILTY. PROCEEDINGS WILL THEN BE TRIED IN YOUR |
| ABSENCE AND JUDGMENT WILL BE RENDERED WITHOUT FURTHER NOTICE. |
|__________________________________________________________________________________|
IF YOU ARE CONVICTED BY DEFAULT, ADDITIONAL COSTS MAY BE IMPOSED..
DEMERIT POINT
The demerit points indicated on the statement of offence serve only as a guideline. The Société de l’assurance automobile du Québec is responsible for registering demerit points in a defendant’s record.
RIGHT TO LEGAL COUNSEL
You have the right to seek legal counsel before entering a plea or making a preliminary application.
__________________________________________________________________________________
| |
| INFORMATION |
| |
| |
| |
| PROSECUTOR’S ADDRESS (IF APPLICABLE) |
|__________________________________________________________________________________|
DEFENDANT
O.C. 1211-97, Sch. V; O.C. 140-2000, ss. 3, 4 and 5; O.C. 973-2003, s. 16; O.C. 633-2006, ss. 13, 14 and 15; I.N. 2016-01-01.
REFERENCES
O.C. 1211-97, 1997 G.O. 2, 5074
O.C. 140-2000, 2000 G.O. 2, 985
O.C. 973-2003, 2003 G.O. 2, 2980
O.C. 633-2006, 2006 G.O. 2, 2118
S.Q. 2005, c. 34, s. 87