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 – Commencement of Authorization Form

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

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

I , herby authorize to act as my representative in all matters for the purposes of the above noted proceeding before the Ontario Land Tribunal.

Representative’s Contact Information
Last Name :					First Name :
Name of firm or organization (if applicable):
Email Address:
Daytime Telephone Number:					Alternative Telephone Number:
			Ext.
Postal adress
Unit Number :			Street Number :		Street Name :			P.O. Box
City/Town :			Province:		Country :			Postal Code:

Representative’s Declaration
I declare that the information provided above is truthful, complete and correct. I acknowledge that I am either licensed by the Law Society of Ontario (LSO) to provide legal services or that I am an unlicensed representative covered by an exemption allowed by the LSO. I have been authorized by the appointing party to represent him/her/it throughout the proceeding before the Ontario Land Tribunal and have the authority to bind the party with respect to withdrawal and all other issues.
___________________________
Signature of Representative	Date (yyyy/mm/dd)