Government of Ontario

Tribunals Ontario
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/

Notice of Appeal – Liquor Licence Act, Gaming Control Act, 1992, Vintners Quality Alliance Act, 1999, Alcohol and Gaming Regulation and Public Protection Act, 1996

Important Information

Appellant Name and Contact Information:











Information about the Decision / Order / Proposal You are Appealing:

I am filing my appeal within the deadline indicated on the decision/order/proposal.

Reasons You are Making this Appeal:


Acknowledgement

Read carefully then check each box to confirm the statement and sign and date the form.

I have served a copy of page 1 and 2 of this form and all additional attached documents to the Registrar of the Alcohol and Gaming Commission of Ontario. I have attached a completed ' Certificate of Service' to this form as proof of service of the documents on the Registrar. (Blank 'Certificate of Service' forms are available on the Tribunal's website at www.slasto-tsapno.gov.on.ca/lat-tamp/en/)


The following section is not part of your disclosure to the other parties. Submit this section to the Tribunal only.

Payment Information:

Acceptable Methods of Payment:
If you are filing your appeal … You must pay by ...
by fax credit card
by mail or courier credit card
certified cheque
money order
bank draft

I am paying my $106 filing fee by:



* If you are paying by credit card, you must provide the following information:






The information you provide on this sheet is confidential. It will be used to process your application, but will not be placed on your file.

For Licence Appeal Tribunal Office Use Only:


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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