SCHEDULE 4

NOTICE OF APPEAL (INFORMAL PROCEDURE)
(SECTION 4)

--------------------

TAX COURT OF CANADA

BETWEEN:

(name)

Appellant,

and

HER MAJESTY THE QUEEN,

Respondent.

NOTICE OF APPEAL

TAKE NOTICE THAT (name) appeals to the Court from (identify the assessment(s) (which include(s) a reassessment and an additional assessment) under appeal, including the date of the assessment(s) and the period to which the assessment(s) relate(s)).

A. Reasons for the appeal. Here state why you say the assessment(s) is (are) wrong.

B. Statement of relevant facts in support of the appeal.

I ELECT to have the informal procedure provided by sections 18.3001 and 18.3003 to 18.302 of the Tax Court of Canada Act apply to this appeal.

DATE:

____________________
(Signature)

TO:
The Registrar
Tax Court of Canada
200 Kent Street
Ottawa, Ontario
K1A 0M1

or

Any other office of the Court mentioned in section 2.

(Set out name, address for service and telephone number of appellant, appellant’s counsel or appellant’s agent)