Canada IN THE ___________________________ COURT NS Form 52/49

Province of Nova Scotia NSY 120

Revised 02/05
Her Majesty the Queen
v. Approved:

______________________________________________ __________________
(Name and I.D. number of Accused/Young Person) Judge

WARRANT OF REMAND AND COMMITTAL __________________

(To a Hospital) D/M/Y
(Secs. 672.13, 672.29, 672.57 CC)

TO: All Peace Officers in the Province of Nova Scotia

AND TO: The Superintendent of a 9 Provincial Correctional Institution 9 Youth Custody Facility
AND TO: Administrator in charge of a Hospital designated by the Minister of Health for Nova Scotia pursuant
to s.672.1 CC (the hospital).

THIS WARRANT is issued for the committal of __________________________________________________________

(name of accused/young person)
of _______________________________________________________________ (the accused/young person).
(address)

The accused/young person has been charged with the following offence(s):

Case No. and Brief Date of

Description of Offence Section Offence Place

AND the accused/young person has been*:

9 ordered to have his/her mental condition assessed (S. 613 CC)
9 found fit to stand trial, but there are reasonable grounds to believe the accused/young person would
become unfit if released
9 found unfit to stand trial
9 found not criminally responsible on account of mental disorder

I COMMAND YOU, the Peace Officer, to take the accused/young person into your custody, and convey the accused/young
person safely to the hospital and there deliver the accused/young person to the administrator.

9 If necessary, while awaiting transfer to the hospital, or while being transferred from the hospital back to the court, the
accused/young person may be held at a 9 Provincial Correctional Institution 9 Youth Custody Facility

I COMMAND YOU, the Administrator, to receive the accused/young person into your custody and to keep the
accused/young person safely there until the accused/young person is

9 delivered to the ______________________ Court at _________________________________________,

Nova Scotia, Courtroom #_______________ on __________________________________, 20_____ at
__________ ____ m.

9 delivered by due course of law.

THE FOLLOWING are the conditions to which the accused/young person shall be subject while in your custody: (Use
schedule if necessary.)

DATED at _________________________________, Nova Scotia, on ____________________________, 20 ____.

__________________________________________
*Check applicable option Judge, Clerk

Distribution: Court, Accused/Young Person, Prosecutor, Defence Counsel, (Parent)

Chair, Criminal Code Review Board, P. O. Box 7, Halifax, NS B3J 2L6
9 East Coast Forensic Psychiatric Hospital
9 Youth Forensic Service

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