Form 5.05A
(rule 5.05)

Concurrent Originating Document

I certify this to be a concurrent originating document, (as amended) filed with the Supreme Court of Newfoundland and Labrador, General Division. 

ISSUED at 				  (city/town) in the Province of Newfoundland and Labrador this 		 (day) of 			 (month), 		 (year).

(Affix court seal)

Registrar/Registry Clerk