Spouse Declaration and/or
Plate Transfer Declaration
Office Use Only
Office Number
Operator Number
Fee Paid ($)
Method of Payment
Cash
Effective Date (yyyy/mm/dd)
Credit Card
Cheque
Business Date (yyyy/mm/dd)
Personal ID Viewed and Number
Stock Issued
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.
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,
to
Last Name, First Name
Last Name, First Name
authorize the transfer of my stored credit on
Driver Licence/Registrant Identification Number
Plate Number
.
Signature
Date (yyyy/mm/dd)
Signature
Date (yyyy/mm/dd)
SR-LV-139E (2014/10)
© Queen's Printer for Ontario, 2014
Disponible en français
Page 1 of 2
Plate Transfer Declaration (Family Members only)
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,
Driver Licence/Registrant Identification Number
Last Name, First Name
authorize the transfer of my licence plate number
Plate Owner Signature
Plate Number
to
Last Name, First Name
Date (yyyy/mm/dd)
Recipient's Section
I,
Last Name, First Name
acknowledge that licence plate
Driver Licence/Registrant Identification Number
Plate Number
may go into plate denial for unpaid amounts incurred against the licence plate before and/or after the date of transfer. 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. Direct general inquiries to Service Ontario at 416 235-2999 or 1 800 387-3445 or visit ServiceOntario.ca.
Print Form
SR-LV-139E (2014/10)
Clear Form
Page 2 of 2