Animal Care Review Board
Safety, Licensing Appeals and
Standards Tribunals Ontario
PO Box 250
Toronto ON M7A 1N3
I am representing (Name of Party)
I acknowledge that I am licensed by the Law Society of Upper Canada (LSUC) to provide legal services.
My LSUC No. is
I acknowledge I am an unlicensed representative covered by an exemption allowed by the LSUC.
Name of Representative
Signature of Representative
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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