Application for Licence as an Operator of a Supply Facility Under the Animals for Research Act

To: Livestock Licensing Coordinator
Livestock Technology
Ontario Ministry of Agriculture, Food and Rural Affairs
1 Stone Rd. West, 3rd Floor NE
Guelph, Ontario N1G 4Y2

Name: ___________________________________________________________

Operating as: ______________________________________________________

applies for a licence as an operator of a supply facility under the Animals for Research Act and the Regulations, and in support of this application the following facts are stated:

1. Location of supply facility:

_________________________________________________________________

2. Owner of premises, if not the applicant _______________________________

_________________________________________________________________

3. Type of species of animals bred and reared on premises:

_________________________________________________________________

4. Operator of the research facility with whom the applicant has a contract:

_________________________________________________________________

_________________________________________________________________

Dated this ____________________ day of ________________________, 20__.

_____________________________________
(Name - please print)

_____________________________________
(Signature of Applicant)

A cheque tendered to the Government of Ontario and not honoured by your bank will be subject to a $35.00 service charge.

The above information is being collected under the authority of the Animals for Research Act. Information will be used for the purpose of licensing. If you have any questions, please call the Livestock Licensing Coordinator at (519) 286-3571.