FORM 28.1
(Subsection 487.03(2))
ENDORSEMENT (ORDER OR AUTHORIZATION)

Canada,
Province of ............,
(territorial division).

Pursuant to application this day made to me, I hereby authorize the execution of this order, in the case of an order issued under section 487.051 or 487.052 (or execution of this authorization in the case of an authorization issued under section 487.055 or 487.091), within the said (territorial division).

Dated this ........ day of .........
A.D. ........, at ............
.................................
Judge of the Provincial Court