Spouse Declaration and/or Plate Transfer …

1 SR-LV-139E (2014/10) Queen's Printer for Ontario, 2014 Page 1 of 2 Disponible en fran aisSpouse Declaration and/or Plate Transfer DeclarationOffice Use OnlyOffice NumberOperator NumberEffective Date (yyyy/mm/dd)Business Date (yyyy/mm/dd)Method of PaymentCashCredit CardChequeDebitFee Paid ($)Personal ID Viewed and NumberStock IssuedSpouse Declaration (Safety Standard Certificate and Drive Clean Pass Exemption)For the purpose of determining eligibility, Spouse has the same meaning as in Part III of the Family Law Act, as stated below:Either of two persons who:(a) are married to each other; or(b) have together entered into a marriage that is voidable or void, in good faith on the part of a person relying on this clause to assert any right;orEither of two persons who are not married to each other and have cohabited,(a) continuously for a period of not less than three years.

2 Or(b) in a relationship of some permanence, if they are the natural or adoptive parents of a Declaration for the Transfer of a vehicle bearingVehicle Identification Number (VIN)WeLast Name, First NameandLast Name, First Nameare spouses as defined in Part III of the Family Law Act stated (yyyy/mm/dd)SignatureDate (yyyy/mm/dd)Stored Credit Transfer Declaration (If applicable, this section must only be completed if the Spouse Declaration above has also been completed.)Donor and Recipient SectionI,Last Name, First Nameauthorize the Transfer of my stored credit onPlate NumbertoLast Name, First NameDriver Licence/Registrant Identification (yyyy/mm/dd)SignatureDate (yyyy/mm/dd)SR-LV-139E (2014/10)Page 2 of 2 Plate Transfer Declaration (Family Members only)For the purpose of determining eligibility, for Plate Transfer , the ministry refers to the following.

3 Spouse /common-law spouseFather/mother, stepfather/stepmotherFather-in-law/mothe r-in-law, son-in-law/daughter-in-law Son/daughter, stepson/stepdaughter (including adopted children)Children and parents in a common-law relationshipPlate Owner SectionI,Last Name, First NameDriver Licence/Registrant Identification Numberauthorize the Transfer of my licence Plate numberPlate NumbertoLast Name, First NameDate (yyyy/mm/dd) Plate Owner SignatureRecipient's SectionI,Last Name, First NameDriver Licence/Registrant Identification Numberacknowledge that licence platePlate Numbermay go into Plate denial for unpaid amounts incurred against the licence Plate before and/or after the date of Transfer .

4 Should the licence Plate go into Plate denial, the licence Plate will not be renewed and/or a new vehicle permit will not be issued until the applicable unpaid amounts are remitted. Applicable unpaid amounts may include charges in respect of Non Sufficient Funds cheques provided to the Ministry, unpaid fines and 407 tolls and related (yyyy/mm/dd)Recipient's SignatureUnder provincial legislation, the penalty for making a false statement may include a fine and/or imprisonment and/or a driver s licence suspension. Information on this form is collected under the authority of the Highway Traffic Act.

5 If you have any questions about the collection and use of your personal information collected on this form, please call the Supervisor, Service Ontario at 416 235-2999 or 1 800 387-3445 or write to the Supervisor, Ministry of Transportation, Licensing Administration and Support Office, Main Floor, Building A, 1201 Wilson Avenue, Downsview ON M3M 1J8. Direct general inquiries to Service Ontario at 416 235-2999 or 1 800 387-3445 or visit