the

day of

Robbery.

The Jurors for our Lady the Queen, upon their oath, present that A. B., on

at

did feloniously rob C. D (and at the time of, or immediately before or after such robbery (if the case is so), did cause grievous bodily harm to the said C. D.), (or to any person, naming him.)

Burglary.

County (or district)} upon their oath, present that A. B., on

The Jurors for our Lady the Queen,

of

the

to wit:

day of

at

did feloniously break into and enter the dwelling-house of C. D., in the night-time, with intent to commit a felony therein (or as the case may be.)

Stealing Money.

The Jurors for our Lady the Queen,

County (or district)} upon their oath, present that A. B., on

of

the

sum of

money, to wit, to the amount of of one C. D. (or as the case may be.)

dollars, the property

The Jurors for our Lady the Queen, upon their oath, present that A. B., on

at

being a servant (or clerk)

then employed in that capacity by one C. D., did then and there, in virtue thereof, receive a certain sum of money, to wit, the amount of

for and on account of the said C. D., and the

said money did feloniously embezzle.

False Pretences.

County (or district)} upon their oath, present that A. B., on

The Jurors for our Lady the Queen,

at , unlawfully, fraudulently and knowingly, by false pretences, did obtain from one C. D., six yards of muslin, of the goods and chattels of the said C. D., with intent to defraud.

Offences against the Habitation.

The Jurors for our Lady the Queen,

County (or distreupon their oath, present that A. B., on

of

the

to wit:

day of

at

did feloniously and maliciously

set fire to the dwelling-house of C. D., the said C. D. (or some other person by name, or if the name is unknown), some person being therein.

Malicious Injuries to Property.

County (or district)} upon their oath, present that A. B., on

The Jurors for our Lady the Queen,

of

to wit:

the day of

at

, did feloniously and maliciously

set fire, or attempt to set fire, to a certain building or erection, that is to say (a house or barn or bridge, or as the case may be,) the property of one C. D. (or as the case may be).

County (or district) Į

of

the

to wit:

, day of

Forgery.

The Jurors for our Lady the Queen,

}upon their oath, present that A. on

did feloniously forge (or utter, knowing the same to be forged) a certain promissory note, &c. (or clandestinely and without the consent of the owner, did make an alteration in a certain written instrument with intent to defraud, or as the case may be).

Coining,

County (or district)} upon their oath, present that A. B., on

The Jurors for our Lady the Queen,

did feloniously counterfeit a gold coin of the United Kingdom, called a sovereign, current by law in Canada, with intent to defraud, (or had in his possession a counterfeit of a gold coin of the United Kingdom, called a sovereign, current by law in Canada, knowing the same to be counterfeit, and with intent to defraud by uttering the same.)

to wit, at the (assizes) holden for the county (or district) of before (one of the judges

on the

day of

of our Lady the Queen), a certain issue between one E. F. and one J. H., in a certain action of covenant, was tried, upon which trial A. B. appeared as a witness for and on behalf of the said E. F., and was then and there duly sworn before the said and did then and there, upon his oath, aforesaid, falsely, wilfully and corruptly depose and swear in substance and to the effect following, "that he saw the said G. H. duly execute the deed on which the said action was brought," whereas, in truth, the said A. B. did not see the said G. H. execute the said deed, and the said deed was not executed by the said G. H., and the said A. B. did thereby commit wilful and corrupt perjury.

Subornation of Perjury.

County (or district) Same as last form to the end, and then of to wit: proceed:-And the jurors further present, that before the committing of the said offence by the said A. B., to wit, on the

day of

at

C. D., unlawfully,

wilfully and corruptly did cause and procure the said A. B. to do and commit the said offence in manner and form aforesaid.

Offences against the Public Peace.

County (or district)} upon their oath, present that A. B., on,

The Jurors for our Lady the Queen,

of

to wit:

the day of

at

with two or more persons, did riotously and tumultuously assemble together to the disturbance of the public peace, and with force did demolish, pull down or destroy (or attempt or begin to demolish, &c.), a certain building or erection of C. D.

Offences against the Administration of Justice.

County (or district)} upon their oath, present that A. B., on

The Jurors for our Lady the Queen,

of

the

did corruptly take or receive money under pretence of helping C. D. to a chattel (or money, &c.), that is to say, a horse (or five dollars, or a note, or a carriage), which had been stolen (or as the case may be).

Bigamy or offences against the Law for the Solemnization

of Marriage.

County (or district) upon their oath, present that A. B., on

The Jurors for our Lady the Queen,

of

the

to wit:

at

day of being then married, did feloniously marry C. D. during the lifetime of the wife of the said A. B.-(or not being duly authorized, did solemnize or assist in the solemnization of) a marriage between C. D. and E. F., or being duly authorized to marry, did solemnize marriage between C. D. and E. F. before proclamation of banns according to law, or without a license for such marriage under the hand and seal of the Governor.)

Offences relating to the Army.

County (or district)ì

of

the

to wit: day of

The Jurors for our Lady the Queen, upon their oath, present that A. B., on

at

did solicit (or procure a soldier to desert the Queen's service (or as the case may be).

Offences against Public Morals and Decency.

County (or district)} upon their oath, present that A. B., on

The Jurors for our Lady the Queen,

of

to wit:

the day of

bawdy or disorderly house (or rooms).

General Form.

County (or district) upon their oath, present that A. B., on

The Jurors for our Lady the Queen,

in the terms in which it is described in the law, or state such facts as constitute the offence intended to be charged, and if the offence is felony, state the act to have been done feloniously.)

THIRD SCHEDULE.

Whereas at (stating the session of the court before which the person was convicted,) held for the county (or united counties) of A. B., late of

on

before

having been found guilty of felony, and judgment thereon given, that (state the substance,) the court before whom he was tried reserved a certain question of law for the consideration of the justices of (name of court), and execution was thereupon respited in the meantime (as the case may be): This is to certify that the justices of (name of court) having met at in term (or as the case may be), it was considered by the said justices there, that the judgment aforesaid should be annulled, and an entry made on the record, that the said A. B. ought not, in the judgment of the said justices, to have been convicted of the felony aforesaid; and you are therefore, hereby required forthwith to discharge the said A. B. from your custody.

32-33 V., c. 29, sch. A, and c. 30, sch.;-C. S. U. C., c. 112, sch.; C. S. L. C., c. 77, sch. A.; R. S. N. S. (3rd S.), c. 171, sch. ;-1 R. S. N. B., Title XL, and sch., Form (U)