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
                   1-855-444-7454
Fax:            416-314-4270
                   1-800-720-5292
Website: www.slasto.gov.on.ca

Declaration of Representative

Important Information

1. Representative Information






Address









2. Declaration of Representative


Before the Animal Care Review Board in the matter of (Name of Appellant)



And (Name of Respondent)



3. Acknowledgement







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.

0427E (2019/07)       © Queen’s Printer for Ontario, 2019

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