License Notice of Appeal

Fee(s):

Appeal Fee

$50

Personal Information

Name of Appellant(Required)

First Last

Agent Name (if applicable)

First Last

Address(Required)

Street Address Address Line 2 City Province Postal Code

Phone(Required)

Email(Required)

License / Application Particulars

License Number

License Type(Required)

License Expiry Date

License Application Date

Address of Business (if applicable)

Street Address

My License Was:(Required)

Refused

Suspended

Cancelled

Made Conditional

Reasons For Appeal(Required)

Explain your reasons for appeal and state the material facts upon which this appeal is based. Be specific and provide as much detail as possible.

Supporting Documents

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 128 MB.

Documents supporting your reasons for appeal.

Please Note: An appellant who files a notice of appeal shall at the time of filing the appeal pay a fee of $50.00 which is non-refundable and may not be waived or reduced under any circumstances.

This personal information is collected under the authority of The Local Authority Freedom of Information and Protection of Privacy Act. This information will be used for processing your appeal and will become part of a public agenda. If you have any questions regarding the collection of this information, please contact the Saskatoon License Appeal Board at (306) 975-3240 or 222 – 3rd Avenue North, Saskatoon SK, S7K 0J5.

Date(Required)

Signature(Required)

Please enter your full name.

License Appeal Fee

Price:

Total

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