Licence Appeal Tribunal
PO Box 250 Toronto ON M7A 1N3 Phone: 416-327-6500 Toll Free: 1-844-242-0608 Fax: 416-325-1060 Toll Free: 1-844-618-2566 Website: www.slasto-tsapno.gov.on.ca/lat-tamp/en/
Important Information
Tribunal File Number (if any):
Last Name First Name Middle Initial
Company Operating Name (if applicable) Numbered Company Name (if applicable)
Unit No. Street No. Street Name City Province Postal Code Telephone No. Fax No.
Appellant Respondent Added Party
an order of the Tribunal granting an extension of time to allow me to file my appeal outside of the legislated timeline. an order of the Tribunal granting a stay of the order or decision that I am appealing. an order of the Tribunal removing a stay previously granted by the Tribunal in this matter. an order of the Tribunal an order of the Tribunal (provide details of the type of order you would like the Tribunal to make)
I have attached a copy of the proposal, order or decision this motion relates to and any previous stays granted by the Tribunal.
Describe in detail why you are making this motion and provide details explaining why you believe the Tribunal should grant your request.
Read carefully then check each box to confirm the statement and sign and date the form. I have completed all pages of this form and attached all the required documentation. I understand that if I submit an incomplete form or do not attach required documents, my motion may not be scheduled. I have served a copy of this Notice of Motion and all additional attached documents on all other parties to the appeal and where applicable, on the person who issued the order/decision/proposal that is the subject of my appeal. I have attached a completed 'Certificate of Service' to this form as proof of service of the documents. (Blank 'Certificate of Service' forms are available on the Tribunal's website at www.slasto-tsapno.gov.on.ca/lat-tamp/en/.)
Print Name Signature Date (yyyy/mm/dd)
The Licence Appeal Tribunal collects the personal information requested on this form under section 3 of the Licence Appeal Tribunal Act, 1999. This information will be used to determine appeals under this Act. After an appeal is filed, all information may become available to the public. Any questions about this collection may be directed to the Licence Appeal Tribunal at 416-327-6500 or toll-free at 1-844-242-0608.
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