Spouse Declaration and/or Plate Transfer Declaration

1 Spouse Declaration and/or Plate Transfer Declaration Office Use Only Office Number Operator Number Effective Date (yyyy/mm/dd) Business Date (yyyy/mm/dd). Method of Payment Fee Paid ($) Personal ID Viewed and Number Stock Issued Cash Credit Card Cheque Debit Spouse 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;. or Either of two persons who are not married to each other and have cohabited, (a) continuously for a period of not less than three years; or (b) in a relationship of some permanence, if they are the natural or adoptive parents of a child.

2 Spouse Declaration for the Transfer of a vehicle bearing Vehicle Identification Number (VIN). We and Last Name, First Name Last Name, First Name are spouses as defined in Part III of the Family Law Act stated above. Signature Date (yyyy/mm/dd). Signature Date (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 Section I, authorize the Transfer of my stored credit on Last Name, First Name Plate Number to . Last Name, First Name Driver Licence/Registrant Identification Number Signature Date (yyyy/mm/dd). Signature Date (yyyy/mm/dd). SR-LV-139E (2014/10) Queen's Printer for Ontario, 2014 Disponible en fran ais Page 1 of 2. Plate Transfer Declaration (Family Members only).

3 For the purpose of determining eligibility, for Plate Transfer , the ministry refers to the following: Spouse /common-law Spouse Father/mother, stepfather/stepmother Father-in-law/mother-in-law, son-in-law/daughter-in-law Son/daughter, stepson/stepdaughter (including adopted children). Children and parents in a common-law relationship Plate Owner Section I, Last Name, First Name Driver Licence/Registrant Identification Number authorize the Transfer of my licence Plate number to Plate Number Last Name, First Name Plate Owner Signature Date (yyyy/mm/dd). Recipient's Section I, Last Name, First Name Driver Licence/Registrant Identification Number acknowledge that licence Plate Plate Number may 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 charges. Recipient's Signature Date (yyyy/mm/dd). Under 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. 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.

5 Direct general inquiries to Service Ontario at 416 235-2999 or 1 800 387-3445 or visit Print Form Clear Form SR-LV-139E (2014/10) Page 2 of 2.