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 ___

Address : ________________________________________________________________________________

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

Please update the surviving spouse's or common-law partner's marital status and recalculate
    the CCTB and/or UCCB.

Please update the surviving spouse's or common-law partner's marital status and recalculate
    the GST/HST credit.

Please reassess the surviving spouse's or common-law partner's return to allow a claim for
    the GST/HST credit.

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 partne : ____________________Date :  _______________

Your name : _________________________________________Your telephone number :  _________________

Your address : ____________________________________________________________________________

Your relationship to the deceased* : ___________________________________________________________

*In addition to any personal relationship you may have had with the deceased, please specify whether you are the executor, administrator, or liquidator, or if you are acting in some other capacity.

Privacy Act Personal Information Bank number CRA PPU 040