For the year

Taxpayer

First and Last Name

Taxpayer

SIN#

Taxpayer

Date of Birth MM/DD/YYYY

Taxpayer

Phone #

Spouse

First and Last Name

Spouse

Date of Birth MM/DD/YYYY

Address

Street Number

Address

Street Name

Address

Apartment #

Address

City / Province/ Postal Code

E-mail

Marital Status:

If your marital status changed during the year, provide date of change (mm/dd/yy):

Province or territory of residence on December 31

Did the taxpayer immigrate to Canada or emigrate from Canada during the year?

If yes, provide the date of entry into Canada

or the date of departure

Is the taxpayer a Canadian citizen?

If yes, the taxpayer authorizes the CRA to provide his/her name, address and date of birth to Elections Canada to update his/her information on the National Register of Electors.

6. Dependants

6. Dependants

6. Dependants

6. Dependants

By submitting this form, you consent to the collection and storage of your personal data