I, ________________________________ of ___________________________________ of [city], in the [region], Province of [province], did on the _________ day of [month], 20___, serve [name of accused], this Notice of Application in person at ________________________________, Province of [province], OR
[name of accused] accepted service of the Notice of Hearing on behalf of ____________________________
________________________
Peace Officer
SWORN/AFFIRMED TO at [city], in the region of
[region], Province of
[province], this [day]
day of [month], 20____, before me:
________________________________
Commissioner of Oaths/Justice of the Peace
for the province of [province]