OLT Case Number:
Municipality:
My name is: (name)
I live at the: (municipality)
in the: (county or region)
in the: (province)
I have been engaged by or on behalf of (name of party/parties) to provide evidence in relation to the above-noted Ontario Land Tribunal (`Tribunal`) proceeding.
I acknowledge that it is my duty to provide evidence in relation to this proceeding as follows:
Date: Signature: