OLT Case No.:

Hearing Date:

Municipality:

Request can only be made by Party or Representative

Last Name:

First Name:

Company Name or Association Name (Association must be incorporated – include copy of letter of incorporation):

Email Address:

Daytime Telephone Number: ext.

Alternative Telephone Number:

Mailing Address:

Unit Number: Street Number:

Street Name: P.O. Box:

City/Town: Province:

Country: Postal Code:

Party (please check appropriate box)

Applicant  Appellant  Municipality  Other

If filing the request as a representative, please identify your client (party):

Reasons in support of the request to adjourn:

If the Tribunal directed you to provide notice of the hearing event, has notice been given?  Yes No N/A

Consent from all parties obtained and attached?  Yes No

If No, please provide details:

Request to Adjourn to: (Month, Year)

Suggested Dates: (Agreeable to all parties)

Please return the completed form and any supporting documents to the Tribunal’s Office by email where possible. If unable to supply via email, please provide via mail.