*** Transcriber's Note::Please set your voice synthesizer to read most punctuation. When you encounter the caret sign at the end of a line, please enter the applicable information, if necessary. *** Canada Revenue Agency Protected B when completed RC4111 E (25) Notify the Canada Revenue Agency of a Death You need to provide the Canada Revenue Agency (CRA) with the deceased person's date of death as soon as possible. You can call the CRA at 1-800- 959-8281, or complete this form and send it to the deceased person's tax centre. You can find the mailing addresses at canada.ca/tax-centres. Information about the deceased person Name: ^ Social insurance number (SIN) or Temporary Tax Number (TTN) (enter 9 digits): ^ Date of birth (Year/Month/Day): ^ Date of death (Year/Month/Day): ^ Address: ^ Your information Name: ^ Telephone number (including area code): ^ Address: ^ Relationship to the deceased person: ^ Signature: ^ Date (Year/Month/Day): ^ Personal information (including the SIN) is collected and used to administer or enforce the Income Tax Act and related programs and activities including administering tax, benefits, audit, compliance, and collection. The information collected may be disclosed to other federal, provincial, territorial, aboriginal, or foreign government institutions to the extent authorized by law. Failure to provide this information may result in paying interest or penalties, or in other actions. Under the Privacy Act, individuals have a right of protection, access to and correction of their personal information, and to file a complaint with the Privacy Commissioner of Canada regarding the handling of their personal information. Refer to Personal Information Bank CRA PPU 005 on Info Source at canada.ca/cra-info- source.