Government of Ontario: Ministry of Community Safety and Correctional Services

Office of the Chief Coroner

Warrant for the Provision of Names from the Jury Roll

The Coroners Act – Province of Ontario

To: (Name of sheriff)

I direct that you provide me from the jury roll prepared under the Juries Act, the names of

persons, together with their ages, places of residence, occupations and respective numbers on the jury roll required for service as jurors at an inquest or inquests to be held in the (municipality )

Dated this (day) day of (month) 20 at (location)

Coroner’s Name (Please print)

Coroner’s Signature