Ontario Land Tribunal 655 Bay Street, Suite 1500, Toronto, ON M5G 1E5 Tel: 416-212-6349 | 1-866-448-2248 Web Site: olt.gov.on.ca

Representative of a Party – Cessation of Authorization Form

Date of Notification to the Tribunal (yyyy/mm/dd):

Case Information
OLT Case No.:	Hearing Date (if known):	Municipality:

I (Name of Representative) , herby announce that I intend to cease acting as a representative for(Name of Party) as of (Date (yyyy/mm/dd)) in a proceeding before the Ontario Land Tribunal concerning the above noted case number.

_______________________________
Signature of Representative	Date (yyyy/mm/dd)

Party's Declaration

I declare that the information above is truthful, complete and correct. I acknowledge that I am aware that (Name of Representative) Intends to cease acting as my representative as of Date (yyyy/mm/dd) .

_______________________________
Signature of Party	Date (yyyy/mm/dd)