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Notice to DASH - Eviction for Illegal Act

Use this form to notify DASH about a former tenant or co-op member whose tenancy or occupancy was terminated by the Landlord and Tenant Board due to a serious illegal act, including:

production, trafficking, or possession for the purpose of trafficking an illegal drug
illegal production, distribution or sale of cannabis
physical violence or attempted physical violence against another person
physical harm, attempted physical harm, or a risk of physical harm to another person
human trafficking
use of threats to, intimidation of, and harassment of another person.
llegal production, distribution or sale of cannabis attempted physical violence against another person.

This informtion will be retained for 5 years and may be shared with other housing providers if requested at the time of a future offer of housing.

Name of Former Tenant or Co-op Member:

Aliases

SIN:

Date of Birth

Date of eviction (as ordered by the Landlord and Tenant Board):

LTB Order Number

Street Address:

City/Town:

Name of Property

Unit #

Name of Former Co-Tenant/Member:

Co-tenant/member SIN:

Co-tenant/member Date of Birth

Other information:

Name of Housing Provider:

Staff Contact Name and Title:

Email:

Provider Telephone: