Government of Ontario

Licence Appeal Tribunal

15 Grosvenor Street, Ground Floor
Toronto ON M7A 2G6
Phone: 416-326-1356
Toll Free: 1-888-444-0240
Email: LATregistrar@ontario.ca
Website: www.tribunalsontario.ca/lat

Notice of Withdrawal

Important Information

If you do not want to continue with your appeal, you must provide a written notice of withdrawal to the Tribunal and to the other parties to the appeal.
By withdrawing the appeal, the Tribunal file will be closed and your rights to a hearing before the Tribunal are terminated.

Notice of Withdrawal:

In the matter of Licence Appeal Tribunal file number
Licence Appeal Tribunal file No.

I, the Appellant
Appellant Name: Last Name
Appellant Name: First Name
withdraw my appeal before the Tribunal. I understand that, by withdrawing my appeal, my file will be closed and my rights to a hearing before the Tribunal in this matter will be terminated.

Copy to Respondent:

I have sent a copy of this Notice of Withdrawal to the Respondent, or their representative,
Name of Respondent or their Representative: Last Name
Name of Respondent or their Representative: First Name

By the following method:

Facsimile Courier Personal Delivery Regular Mail

at the following facsimile No. / address

Address Notice of Withdrawal was delivered to:

Street No. and Name, Unit No.
City
Province
Postal Code

or Facsimile Number of Withdrawal was delivered to

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 416-326-1356 or toll-free at 1-888-444-0240