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TX19 E (09) (Front) 
 
Canada Revenue Agency 
 
ASKING FOR A CLEARANCE CERTIFICATE 
 
Use this form if you are the legal representative for an estate, business, or 
property and you are asking DO NOT USE THIS AREA 
 
for a clearance certificate. A legal representative includes an executor, 
administrator, liquidator, trustee, or like person other than a trustee in 
bankruptcy. 
 
Send this form to the Assistant Director, Audit, at your tax services office. 
Do not attach this form to the return. You can find the address of your tax 
services office on our Web site at www.cra.gc.ca/contact. 
 
Do not send us this form until: 
 
- you have filed all the required tax returns and have received the related 
notices of assessment; and 
 
- we have received or secured all income taxes (including the provincial or 
territorial taxes we administer), Canada Pension Plan contributions, 
Employment Insurance premiums, and any related interest and penalties. 
 
Attach to this form the documents listed below to help us issue the 
certificate without delay: 
 
- a copy of the will, including any codicils, renunciations, disclaimers, and 
all probate documents (If the taxpayer died intestate, also attach a copy of 
the document appointing an administrator and details of the proposed 
distribution of assets, including the names, addresses, and social insurance 
numbers or account numbers of the beneficiaries, and his or her relationship 
to the deceased.); 
 
- a copy of the trust document; 
 
- a statement showing the properties and the distribution plan, including the 
date chosen for the distribution of properties, and a list of the recipients 
of each of the properties (for each property, provide a description, the 
adjusted cost base, and the fair market value at the date of death or 
distribution); 
 
- any other documents that are necessary to prove that you are the legal 
representative; and 
 
- a letter of authorization that you have signed if you want us to 
communicate with someone else. 
 
For more information, refer to the Information Circular 82-6, Clearance 
Certificate or call 1-800-959-8281. 
 
Identification area 
 
Name of deceased, corporation, or trust, whichever applies ^
 
Address ^
 
Social insurance number, Business Number, or trust number, whichever applies 
^
Date of death or date of wind-up, whichever applies ^
 
Legal representative's name (if there is more than one, please provide the 
details on a separate sheet) ^
 
Legal representative's address (we will send the clearance certificate to 
this address) ^
 
Legal representative's capacity (for example, executor, administrator, 
liquidator, or trustee) ^
Telephone number (including area code) ^
 
Period covered 
 
I am asking for a clearance certificate for the period ending ^
(The period ending date is the date that all the obligations or duties of the 
will or other final document of the deceased have been satisfied.) 
 
Tax returns filed 
 
Have you filed any tax returns for the year of death? Yes or No ^
If yes, indicate what type of tax return(s) you filed. For more information, 
get guides T4011, Preparing Returns for Deceased Persons, T4012, T2 
Corporation Income Tax Guide, and/or T4013, T3 Trust Guide. 
 
T1 final return ^
T1 return for income from a testamentary trust ^
T1 return for rights or things ^
T1 return for partner or proprietor ^
T2 Corporation Income Tax Return ^
T3 Trust Income Tax and Information Return ^
 
Certification and undertaking 
 
I am asking for a clearance certificate from the Minister of National 
Revenue. The certificate will certify that all taxes (including provincial or 
territorial taxes administered by the Canada Revenue Agency), Canada Pension 
Plan contributions, Employment Insurance premiums, and any related interest 
and penalties for which the deceased, corporation, or trust named above is 
liable (or can reasonably be expected to become liable) have been paid or 
that the Minister has accepted security for the amounts. The certificate will 
apply to the tax year in which the distribution is made and any previous year 
for which I am liable (or can reasonably be expected to become liable) as the 
legal representative of the deceased, corporation, or trust identified. I 
will complete the distribution of all of the property as soon as possible 
after I receive the clearance certificate. 
 
Capacity (for example, executor, administrator, liquidator, or trustee) ^
Signature ^
Date (Year/Month/Day) ^
 
Capacity (for example, executor, administrator, liquidator, or trustee) ^
Signature ^
Date (Year/Month/Day) ^