Notice to the reader:
We do not accept photocopies or facsimile copies of this form when completed and signed. Send only the original certified form.
You can view this form in:
PDF t2201-12e.pdf (68 KB)
PDF fillable t2201-fill-12e.pdf (285 KB)
For people with visual impairments, the following alternate formats are also available:
E-text t2201-12e.txt (48 KB)
Braille t2201-12e.brf (46 KB)
Large print t2201-lp-12e.pdf (176 KB)
Last update: 2013-01-03
Available in print: 2013-01-03
For more information, see our help file.
You can also order printed copies and
multiple formats of this
form, such as large print, Braille, audio, and E-text (accessible electronic text).