Request for the Canada Revenue Agency to update records

From: Canada Revenue Agency

Complete the information below concerning the deceased.

Name of deceased : __________________________________________

Deceased's social insurance number : _____  _____  _____

The deceased's date of birth :  Year ___ Month ___ Day ___

The deceased's date of death : Year ___ Month ___ Day ___

Deceased's address : __________________________________________

Complete the applicable information below concerning the
surviving spouse or common-law partner.

Name of surviving spouse or common-law partner : _____________________________________

Surviving spouse's or common-law partner's social insurance number : _____  _____  _____

Signature of surviving spouse or common-law partner: ____________________ Date :  ____________

Your name : __________________________________________

Your telephone number : _________________

Your address : __________________________________________

Your relationship to the deceased Footnote 1 :__________________________________________

Mail this form to the deceased’s tax centre. You can find the mailing addresses of our tax centres,
at Tax centres.

Personal information (including the SIN as a personal identifier) is collected for the purposes of the administration or enforcement of the Income Tax Act and related programs and activities. This includes administering benefits, audit, compliance, and collection activities. It may be shared or verified with other federal, provincial, territorial or foreign government institutions to the extent authorized by law. Failure to provide this information may result in interest payable, penalties or other actions. Under the Privacy Act, individuals have the right to access their personal information, request correction, or file a complaint to the Privacy Commissioner of Canada regarding the handling of the individual’s personal information. Refer to Info Source, Personal Information Bank CRA PPU 005.

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