Change of Address form - CivicWeb

ONTARIO COURT OF JUSTICE

PROVINCIAL OFFENCES OFFICE

76 PINE STREET, BRACEBRIDGE, ONTARIO P1L 0C4

705-645-1231

Fax 705-645-5319

1-800-461-4210 in area code 705 only

CHANGE OF ADDRESS FORM

Ticket # 2460-_______________________

I, _______________________________, being the defendant in the above

referenced charge, have changed my address since filing my Notice of

Intention to Appear and my current address for service is:

_____________________________________________________________.

Address

Town

Province Postal Code

Dated at _________________ this ______ day of ___________ , 20___ .

_________________________ Defendant's name

_________________________ Defendant's Signature

_________________________ Witness' name

_________________________ Witness' signature

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