Government of Ontario

Animal Care Review Board
Safety, Licensing Appeals and
Standards Tribunals Ontario

PO Box 250
Toronto ON  M7A 1N3
Telephone: 416-212-0334
Fax:            416-314-4270

Notice of Withdrawal

Important Information

1. Notice of Withdrawal

I, the Appellant

withdraw my appeal before the Board. I understand that by withdrawing my appeal, no further hearings will be held and that my file with the Board will be closed.

2. Copy to Respondent

I have sent a copy of this Notice of Withdrawal to the Respondent (OSPCA) or their representative.

Name of Recipient

By the following method                            

at the following fax number or address

3. Signature

The Animal Care Review Board collects the personal information requested on this form under section 17 of the Ontario Society for the Prevention of Cruelty to Animals Act. This information is being collected for the purpose of conducting a proceeding before the ACRB. Any questions about this collection may be directed to the Animal Care Review Board at 416-212-0334 or toll-free at 1-855-444-7454.

0425E (2014/03)       © Queen’s Printer for Ontario, 2014

Disponible en français