Licence Appeal Tribunal
PO Box 250
Toronto ON M7A 1N3
Toll Free: 1-844-242-0608
Toll Free: 1-844-618-2566
FOR THE SUMMONS REQUESTOR
In the matter of
Name of Appellant: Last Name
Name of Appellant: First Name
Name of Respondent: Last Name
Name of Respondent: First Name
Licence Appeal Tribunal File No.
Name of Witness: Last Name
Name of Witness: First Name
Street No. and Name, Unit No.
Describe the relationship of this witness to this case.
You are hereby summoned and required to attend before the Licence Appeal Tribunal of Ontario at a hearing to be
held at the following address:
or if teleconference, phone number to be used
On the date of (yyyy/mm/dd)
at the time of
Time including AM/PM (hh:mm)
You are required to bring with you and produce at the hearing, the following documents and things
List all the documents and items the witness should bring with them.
Subsections 11(1) and (2) of Statutory Powers Procedure Act, R.S.O. 1990, c. S.22 as amended provide as follows:
If you fail to attend or remain in attendance as this summons requires, the Superior Court of Justice may order that
a warrant for your arrest be issued, or that you be punished in the same way as for contempt of court.
Signature of the Tribunal
Date Signed (yyyy/mm/dd)
FOR THE WITNESS BEING SUMMONED
This summons was issued at the request of, and inquiries may be directed to:
Name of Requestor: Last Name
Name of Requestor: First Name
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.
02028E (2019/06) © Queen’s Printer for Ontario, 2019
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