Government of Ontario

Tribunals Ontario
Animal Care Review Board

Notice of Withdrawal

Important Information

• If you do not want to continue with your appeal, use this form to provide written notice of your withdrawal to the Board and to the other party to the appeal.
• If you withdraw your appeal, no hearing before the Board will take place and your appeal file will be closed.
• This means that the Chief Animal Welfare Inspector's Order that you appealed may be enforced against you unless you have entered into a written agreement with the Chief Animal Welfare Inspector.

1. Notice of Withdrawal

I, the Appellant

Last Name
First Name
Middle Initial

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 Chief Animal Welfare Inspector or their representative.

at the following fax number or address

Address Notice of Withdrawal was delivered to

Unit Number
Street Number
Street Name
PO Box
City/Town/Municipality
Province   AB - Alberta BC - British Columbia MB - Manitoba NB - New Brunswick NL - Newfoundland and Labrador NS - Nova Scotia NT - Northwest Territories NU - Nunavut ON - Ontario PE - Prince Edward Island QC - Quebec SK - Saskatchewan YT - Yukon
Postal Code

Fax Number or Email Address Notice was sent to

3. Signature

Name

Signature


Date (yyyy/mm/dd)

The Animal Care Review Board (ACRB) collects the personal information requested on this form under section 38 of the Provincial Animal Welfare Services Act and section 9(5) of Ontario Regulation 443/19 for the purpose of conducting an appeal proceeding before the ACRB. All information, including sensitive personal and financial information, submitted as part of a proceeding may become public in an open hearing and may be contained in decisions, orders, and case files, unless an order to restrict access is made. Any questions about the collection of information may be directed to the ACRB at ACRB.registrar@ontario.ca.

If you have any questions, please contact

Animal Care Review Board
15 Grosvenor St, Ground Fl
Toronto ON  M7A 2G6
Telephone: 416-327-0111 / 1-888-777-3616
Teletypewriter (TTY): 1-800-855-0511
Fax: 416-314-4270 / 1-800-720-5292
Website: tribunalsontario.ca/acrb
Email: ACRB.registrar@ontario.ca