Petawawa Military Family Resource Centre

OP Family Readiness - May 2020

Petawawa Military Family Resource Centre

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Protected B when completed Part 3 – Authorization expiry date Enter an expiry date, if applicable, otherwise the authorization will stay in effect until you or your representative cancels it or we are notified of your death. Year Month Day Part 4 – Cancel one or more existing authorizations Complete this section only to cancel an existing authorization. Tick the appropriate box. Cancel all authorizations or Cancel the authorizations given for the individual, group, or business identified below: RepID First name: Last name: GroupID Name of group: Business number (BN) Name of business: Part 5 – Signature and date If you are the taxpayer, you must sign and date this form. If you are the legal representative, you must tick the box below, and sign and date this form. I am the legal representative for this taxpayer or estate/trust (executor/administrator, power of attorney, the legal guardian or the trustee or custodian of this trust account). Important: You must send a complete copy of the legal document giving you the authority to act in this capacity to the taxpayer's tax centre. Read the attached information sheet for tax centre addresses. If two or more legal representatives are acting jointly on the taxpayer's behalf, each representative must sign below. Print name of taxpayer or each legal representative X Signature of taxpayer or each legal representative, a parent if taxpayer is under the age of 16, a witness when signed with a mark Year Month Day Date of signature If your representative has not electronically submitted this form on your behalf then it must be submitted within six months of the date of signature. If not, it will not be processed. Privacy Act, personal information bank number CRA PPU 175 G

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