Schedule 1 to the Summary Offence Tickets Regulations (Nova Scotia)

This page is a schedule to the Summary Offence Tickets Regulations, N.S. Reg. 281/2011.
View Legislative History Reference Tables for these regulations.

Schedule 1

Tickets and Forms

Form A - Summary Offence Ticket

Form A-1 - Notice of Intention to Appear in Court

PLEASE PRINT CLEARLY

Ticket Number: _____________________ Indicated on the top of your Summons

Person Named on this Ticket                      Date Requested: ___________________

First and Middle Names: _________________________________________________________

Last Name: ____________________________________________________________________

Date of Birth: __________________________________________________________________

Street:: _______________________________________________________________________

City: ___________________ Province: _____________ Postal Code:________________

Home Phone Number: (___ ) ____________            Work Phone Number: (___ ) ____________

E-mail Address:             Fax Number: (___ ) ____________

Please indicate

1.         I am            the person named on this Ticket.

                                an authorized representative of the company named this Ticket.

        an authorized representative acting with specific instructions of the person named this Ticket.

Authorized Representative Information (complete only if you are not the Person named on this ticket)

First and Middle Names: ________________________________________________________

Last Name: ___________________________________________________________________

   Street: _______________________________________________________________________    City: _________________ Province: _____________ Postal Code: _____________

   Home Phone Number: (___ ) ____________         Work Phone Number: (___ ) ____________

   E-mail Address: _________ ____________          Fax Number: (___ ) ____________

2.          _____  I wish to appear in court to plead not guilty to the alleged offence and have a trial.

                              OR

_______ I wish to appear in court to plead guilty and make a submission as to penalty.

3.          ______  I wish to have my hearing in English French Bilingual.

                              OR

________ I request a language interpreter for my hearing.

4.         What is your preferred method of notification of your court date: _____ E-mail, _____ Fax, _____ Mail.

(The Court will only send notification to one method of notification.)

Send Notification of Court Date to: ______ Person Named on this Ticket, ______ Authorized Representative.

5.         Please indicate the dates that you are unable to attend court, and why you are unable to attend on those dates.

            ____________________________________________________________________

            ____________________________________________________________________

            ____________________________________________________________________

A date for you to appear in Court will be sent by ONE of your preferred notification options: mail, electronic mail or facisimile [facsimile]. You MUST immediately notify the Court indicated on the front of your Summons if there is any change in your mailing address.

Note:

The date for you to appear in Court will be scheduled at the Court indicated on the front of your Summons. If you fail to appear you may be convicted in your absence. If convicted, you will be responsible for any penalty assessed by the Court.

If you do not receive a court date, please contact the Court.

You are entitled to request disclosure concerning the circumstances of your offence from the Crown. You may contact the Court for the address of the local Crown office.

Form A-2 - Certificate of a Justice Striking out a Conviction

(subsections 8(17A) and 8(18) of the Summary Proceedings Act)

To:      (Defendant)

Case Number:

SOT Number:

Offence date:

Charge:

I certify that the conviction entered on the ____ day of _________________, 20 , against the defendant in respect of the offence described above was struck out on the ____ day of _____________, 20 .

__________________________________________
Justice of the Peace or Judge of the Provincial Court

Form B - Parking-Infraction Ticket

$Form B: Parking Infraction Ticket$

Form B-1 - Parking-Infraction Ticket for Halifax Regional Municipality

$Form B-1: Parking-Infraction Ticket for Halifax Regional Municipality$

Form C - Notice of Parking Infraction
In the Provincial Court
for the Province of Nova Scotia

(Ticket number)

NOTICE OF PARKING INFRACTION
(Summons to Appear)

To: (name)
(address)

The informant,(name) says that:

on(date), (province) vehicle number plate(number), registered in your name, was found(specify offence) at(civic #, street, meter #, or place), Nova Scotia, contrary to Section(number)of the (statute, regulation, by-law).

Therefore, you are ordered to attend Court on(date) at(time) at(place), NovaScotia, in Courtroom(number) before the presiding Judge or Justice and to attend as required by the Court.

Dated at, Nova Scotia, on(date).

_______________________________
Parking-Infraction Ticket Administrator
(Municipality)

The following is for information purposes only and does not form part of the parking-infraction notice

PAYMENT OPTIONS

(Set out local payment options)

Form D - Certificate of Service
(Parking-Infraction Ticket Information)

1. I hereby certify that

(a) the parking-infraction ticket(s) shown on the list attached hereto was/were affixed to the vehicle(s) in a conspicuous place or served on the operator of the vehicle(s) at the time of the infraction; and

(b) notice(s) of the parking infraction(s) was/were sent by ordinary mail on the date shown on the list attached hereto, to the owner(s) of the vehicle(s) at the last known name and address of the owner(s) as indicated in the records of the Registrar of Motor Vehicles requiring the owner(s) to appear in Provincial Court at, Nova Scotia, in Courtroom(number)on(date)at(time).

OR

1. I hereby certify that

(a) (municipality)parking-infraction ticket(number)for(offence)at or near(civic #, street, meter #, or place), Nova Scotia, was affixed to the vehicle bearing(province)number platein a conspicuous place on(date); and

OR

(a) (municipality)parking-infraction ticket(number)for(offence)at or near(civic #, street, meter #, or place), Nova Scotia, was served on the operator of the vehicle bearing(province)number plateon(date); and

(b) notice of the parking infraction was sent by ordinary mail on(date)to the last known name and address, as indicated in the records of the Registrar of Motor Vehicles, of the owner of(province)number platerequiring that owner, namely(name)of(address)to appear in Provincial Court at(place)Nova Scotia, in Courtroom(number)on(date)at(time).

2. The out of court penalty for this violation is $ .

Dated at, Nova Scotia, on(date).

____________________________
Parking-Infraction Ticket Administrator
(Municipality)

In the Provincial Court for the Province of Nova Scotia
	(Ticket number)
NOTICE OF PARKING INFRACTION (Summons to Appear)

To:	(name) (address)
The informant,(name) says that:
on(date), (province) vehicle number plate(number), registered in your name, was found(specify offence) at(civic #, street, meter #, or place), Nova Scotia, contrary to Section(number)of the (statute, regulation, by-law).
Therefore, you are ordered to attend Court on(date) at(time) at(place), NovaScotia, in Courtroom(number) before the presiding Judge or Justice and to attend as required by the Court.
Dated at, Nova Scotia, on(date).
_______________________________ Parking-Infraction Ticket Administrator (Municipality)
The following is for information purposes only and does not form part of the parking-infraction notice
PAYMENT OPTIONS
(Set out local payment options)

1.	I hereby certify that
	(a)	the parking-infraction ticket(s) shown on the list attached hereto was/were affixed to the vehicle(s) in a conspicuous place or served on the operator of the vehicle(s) at the time of the infraction; and
	(b)	notice(s) of the parking infraction(s) was/were sent by ordinary mail on the date shown on the list attached hereto, to the owner(s) of the vehicle(s) at the last known name and address of the owner(s) as indicated in the records of the Registrar of Motor Vehicles requiring the owner(s) to appear in Provincial Court at, Nova Scotia, in Courtroom(number)on(date)at(time).
OR
1.	I hereby certify that
	(a)	(municipality)parking-infraction ticket(number)for(offence)at or near(civic #, street, meter #, or place), Nova Scotia, was affixed to the vehicle bearing(province)number platein a conspicuous place on(date); and
	OR
	(a)	(municipality)parking-infraction ticket(number)for(offence)at or near(civic #, street, meter #, or place), Nova Scotia, was served on the operator of the vehicle bearing(province)number plateon(date); and
	(b)	notice of the parking infraction was sent by ordinary mail on(date)to the last known name and address, as indicated in the records of the Registrar of Motor Vehicles, of the owner of(province)number platerequiring that owner, namely(name)of(address)to appear in Provincial Court at(place)Nova Scotia, in Courtroom(number)on(date)at(time).
2.	The out of court penalty for this violation is $ .
Dated at, Nova Scotia, on(date).
____________________________ Parking-Infraction Ticket Administrator (Municipality)