Certificate issued pursuant to paragraph 8(b) of the Aeronautics Act

In the matter of the contravention of by

(specify designated provision)(identify contravener)

It is hereby certified that, at the conclusion of the proceedings held before this Tribunal on , I

(specify date)

assessed the amount of $ to be paid by on or before

(specify amount)(identify contravener)

as a penalty in respect of the contravention of ,

(specify date)(specify designated provision)

which occurred on .

(specify date)

Dated this day of , 20

Signed by:

Name of Tribunal Member

Address of Tribunal