Reference to a Provincial License No.: Court File No.

(s):

Court Judge
Firearms Act
CANADA: Province of Quebec DOB :

Pursuant to Section 74(2) of the Firearms

Act

APPLICANT Name: , ,
surname given name
Residential address: (Home)( ) telephone
street
, Quebec, (Bus.)( ) telephone
city / municipality postal code
Mailing Address: check box if same as residential address or provide

street

city / municipality
Quebec, postal code

Name of Counsel for Applicant

An application is made to the court for a review of the following decision made pursuant to the Firearms Act:
(check applicable box)
Refusal of an Application for a Firearms Licence (Sec. 68 FA)
Refusal of a Carrier Firearms Licence* (Chief Firearms Officer) (Sec. 68 FA)
Refusal of a Carrier Firearms Licence* (Registrar) (Sec. 68 & 73 FA)
Refusal of an Authorization to Transport (Sec. 68 FA)
Refusal to issue a Registration Certificate (Sec. 69 FA)
Refusal to issue an Authorization to Import (Sec. 69 FA)
Refusal to issue an Authorization to Export (Sec. 69 FA)
Revocation of a Firearms Licence (Business or Individual) (Sec. 70 FA)
Revocation of a Firearms Licence (Prescribed Purpose Business) (Sec. 70 FA)
Revocation of a Carrier Firearms Licence (Chief Firearms Officer)* (Sec. 70 FA)
Revocation of a Carrier Firearms Licence (Registrar)* (Sec. 70 & 73 FA)
Revocation of a Authorization to Transport (Sec. 70 FA)
Revocation of a Registration Certificate (Sec. 71 FA)
Revocation of an Authorization to Import (Sec. 70 FA)
Revocation of an Authorization to Export (Sec. 70 FA)
Decision not to approve a shooting club or shooting range (Sec. 29(2) FA)
Decision to revoke approval for a shooting club or shooting range (Sec. 29(3) FA)

The applicant received notice of the decision made by

name of officer
on (Attach copy of notice)
dd / mmm / yy
The reasons on which the application is based are as follows: (if more space is required, add more pages)
Reference to PCJ - Firearms Act

Dated Signature of Applicant

at
Quebec
* NOTE: This review process is not applicable to a refusal or revocation of an Authorization to Carry.

To the Applicant and Chief Firearms officer / registrar / minister

You are required to appear before the Provincial Court Judge on at m
date time
at to present your application and to fix a date for hearing this application
court address

NOTE: Firearms are not to be brought into the courthouse.

PCR 886 08/2008

1–COURT 2–APPLICANT 3–FAX TO QUEBEC DEPARTMENT OF JUSTICE 418-644-4249