Government of Ontario: Ministry of Community Safety and Correctional Services

Office of the Chief Coroner

Sheriff’s List of Names Provided to the Coroner from the Jury Roll

The Coroners Act– Province of Ontario

To: (Name)

In compliance with your warrant dated , requiring the names of persons for service as jurors at an inquest, I submit the following list of names taken from the jury roll prepared under the Juries Act:

1. Name
1. Place of Residence
1. Age
1. Occupation
1. Jury Roll Number

2. Name
2. Place of Residence
2. Age
2. Occupation
2. Jury Roll Number

3. Name
3. Place of Residence
3. Age
3. Occupation
3. Jury Roll Number

4. Name
4. Place of Residence
4. Age
4. Occupation
4. Jury Roll Number

5. Name
5. Place of Residence
5. Age
5. Occupation
5. Jury Roll Number

6. Name
6. Place of Residence
6. Age
6. Occupation
6. Jury Roll Number

7. Name
7. Place of Residence
7. Age
7. Occupation
7. Jury Roll Number

8. Name
8. Place of Residence
8. Age
8. Occupation
8. Jury Roll Number

For

Dated (date) at (location)

(Sheriff’s Name)

Signature