This is the information of (Name of Informant) , a police officer with (Name of Police Force) ,
It is impracticable to appear personally before a court or justice of the peace because (specify circumstances that make it impracticable to appear personally)
I have reasonable grounds to believe that (Name of Offender and Date of Birth (yyyy/mm/dd)) ,
(hereinafter called the “offender”) was,
(check appropriate boxes)
convicted of (Specify Sex Offence(s)) on (Date(s) of Conviction (yyyy/mm/dd)) ; and/or serving sentence for (Specify Sex Offence(s)) ; and/or found not criminally responsible on account of mental disorder for (Specify Sex Offence(s)) on (Date(s) of Finding (yyyy/mm/dd)) ; and/or
made subject to an order in Form 52 under section 490.012 of the Criminal Code (Canada) for an offence referred to in paragraph (b) or (f) of the definition of “designated offence” in subsection 490.011(1) of that Act on (Date of Order (yyyy/mm/dd)) ; and/or
made subject to an obligation under section 490.02901 of the Criminal Code (Canada) (Form 54) to comply with the Sex Offender Information Registration Act (Canada) on (Date of Order (yyyy/mm/dd)) ;and/or
made subject to an obligation under section 36.1 of the International Transfer of Offenders Act (Canada) (Form 1) to comply with the Sex Offender Information Registration Act (Canada) on (Date of Order (yyyy/mm/dd)) ,
and that the offender was resident in Ontario
and is therefore an offender within the meaning of subsection 1(1) of the Christopher’s Law (Sex Offender Registry), 2000, as amended, and was therefore obligated to present himself/herself at a designated bureau, police station or detachment of the (Name of the police force that provides police services where he/she resides) on or before (Date Required to Register (yyyy/mm/dd)) which was,
7 days after he/she was released from custody on (Date of Release (yyyy/mm/dd)) ; or 7 days after he/she was released on parole on (Date of Release (yyyy/mm/dd)) ; or 7 days after he/she was convicted of a sex offence for which he/she received a non-custodial sentence on (Date of Conviction (yyyy/mm/dd)) ; or 7 days after he/she was ordered to serve a sex offence intermittently on (Date of Order (yyyy/mm/dd)) ; or 7 days after he/she was released from custody pending the determination of an appeal in relation to a sex offence on (Date of Release (yyyy/mm/dd)) ; or 7 days after he/she received an absolute or conditional discharge after being found not criminally responsible on account of mental disorder on (Date of Discharge (yyyy/mm/dd)) ; or 7 days after he/she changed his/her address on (Date (yyyy/mm/dd)) ; or 7 days after he/she changed his/her name on (Date (yyyy/mm/dd)) ; or 7 days after he/she became a resident in Ontario (Date(yyyy/mm/dd)) ; or 7 days after he/she ceased to be a resident in Ontario (Date(yyyy/mm/dd)) ; or 7 days after he/she became subject to an obligation under section 490.02901 of the Criminal Code (Canada) (Form 54) to comply with the Sex Offender Information Registration Act (Canada) on (Date (yyyy/mm/dd)) ; or 7 days after he/she became subject to an obligation under section 36.1 of the International Transfer of Offenders Act (Canada) (Form 1) to comply with the Sex Offender Information Registration Act (Canada) on (Date (yyyy/mm/dd)) ; or not later than one year after and not earlier than 11 months after he/she last reported on (Date (yyyy/mm/dd))
and failed to do so in violation of the Act.
I also have reasonable grounds to believe that the offender was notified of his/her obligation to present himself/herself to a police force by way of,
Notification to Offender of Duty to Register (Details) ; and/or Annual Reminder Notice(s) (Details) ; and/or Registration Receipt(s) (Details) ; and/or Other (Details)
I therefore believe that there are reasonable grounds to issue a warrant for the arrest of the offender pursuant to subsection 11(3) of the Act for the purpose of having the offender comply with his/her obligation to present himself/herself at a designated bureau, police station or detachment for the purpose of complying with his/her reporting obligation and that it is in the public interest to do so.
The Informant states that all matters contained in the Information are true to his/her knowledge and belief.
(Signature of Informant)
I certify that this Information was received at (City) at (Time) on the day of ,20 Judge or Justice of the Peace in and for the Province of Ontario