Form SJ-1073A "Application for Consent to Participate in the Court of Quebec Addiction Treatment Program (Cqatp)" - Quebec, Canada

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Download Form SJ-1073A "Application for Consent to Participate in the Court of Quebec Addiction Treatment Program (Cqatp)" - Quebec, Canada

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Procedure
CANADA
COURT OF QUÉBEC
PROVINCE OF QUÉBEC
(Criminal and Penal Division)
District:
Locality:
Court of Québec addiction treatment program (CQATP)
Police force:
File No.:
Statistical code:
HER MAJESTY THE QUEEN
Prosecutor/Respondent
v.
D.O.B.:
Accused/Petitioner
APPLICATION FOR CONSENT TO PARTICIPATE IN THE
COURT OF QUÉBEC ADDICTION TREATMENT PROGRAM (CQATP)
I,
, domiciled at
, ask the prosecutor/respondent to consent to my participation in the
Court of Québec addiction treatment program (CQATP), in relation to the cases mentioned in heading:
I have a judicial file, a copy of which was given to me on disclosure of the evidence.
I have a pending case, including, where applicable, offences before a municipal court and I request the transfer of the
following files to the Court of Québec, Criminal and Penal Division, District of
.
An arrest warrant has been issued against me.
I do not know whether an arrest warrant has been issued against me.
I am under court supervision (including probation follow-up/conditional sentence order):
with follow-up
with community work
1
• SJ-1073A (2013-06)
File
Procedure
CANADA
COURT OF QUÉBEC
PROVINCE OF QUÉBEC
(Criminal and Penal Division)
District:
Locality:
Court of Québec addiction treatment program (CQATP)
Police force:
File No.:
Statistical code:
HER MAJESTY THE QUEEN
Prosecutor/Respondent
v.
D.O.B.:
Accused/Petitioner
APPLICATION FOR CONSENT TO PARTICIPATE IN THE
COURT OF QUÉBEC ADDICTION TREATMENT PROGRAM (CQATP)
I,
, domiciled at
, ask the prosecutor/respondent to consent to my participation in the
Court of Québec addiction treatment program (CQATP), in relation to the cases mentioned in heading:
I have a judicial file, a copy of which was given to me on disclosure of the evidence.
I have a pending case, including, where applicable, offences before a municipal court and I request the transfer of the
following files to the Court of Québec, Criminal and Penal Division, District of
.
An arrest warrant has been issued against me.
I do not know whether an arrest warrant has been issued against me.
I am under court supervision (including probation follow-up/conditional sentence order):
with follow-up
with community work
1
• SJ-1073A (2013-06)
File
Name and contact information of supervision officer:
I am a Canadian citizen.
I am a permanent resident.
I am waiting for the Canada Border Services Agency to rule on my status.
I am waiting for approval of my application for Canadian citizenship.
Other:
I admit the facts described in the police report.
I do not admit the following facts
:
(indicate the concerned file No.)
I consent to the disclosure to the prosecutor/respondent of the information gathered by the certified addiction treatment
resources during my assessment.
I declare that I have received and clearly understood the information concerning the CQATP, and waive my right to trial so
that I can participate in the CQATP.
Accused/Petitioner:
Attorney for the accused/petitioner (or witness):
At
, on
Accused/Petitioner
CONSENT
I consent to the accused/petitioner’s participation in the Court’s addiction treatment program and authorize him/her to
apply to the Court.
I do not allow the accused/petitioner to apply to the Court, and I refuse to have him/her participate in the program.
At
, on
Prosecutor/Respondent
2
• SJ-1073A (2013-06)
File
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