COURT DATA INFORMATION SHEET

Court File #     

Court File Name:        

1.        My Full Name:

2.        I am the in this court proceeding.

3.        My full and complete civic address is:

4.        E-mail address:

5.        Fax Number:

6.        Cell Phone Number:

I certify that any court document served at the civic address noted above will be deemed received by me personally.

Date                                                                            (Signature)

If my civic address noted above changes, I undertake to immediately notify the Prothonotary, in writing of my new address, where I can receive documents relative to this action. If I do not do this, I understand my action or defence could be dismissed without further notice to me.

Date                                                                            (Signature)

I, Annette M. Boucher, Prothonotary, have provided the party above referenced with a copy of Civil Procedure Rule 34 and I have explained the rule to the person noted above making special reference to of Rule 34.06

______________________________

Signature - Prothonotary

I, _____________________, acknowledge that the Prothonotary explained Civil Procedure Rule 34 to me and I undertake to comply with this rule.

___________________                      _______________________________

Date (Signature)