*** 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 RC65 E (07) (Front) Do not use this area MARITAL STATUS CHANGE Use this form to tell us of a change in your marital status. In some situations, you may be eligible for additional Canada Child Tax Benefit (CCTB) and/or goods and services tax/harmonized sales tax (GST/HST) credit payments. See the back of this form for more information. You should tell us as soon as possible after your marital status has changed. However, do not notify us of your separation until you have been separated for more than 90 consecutive days. Information about you First name and initial ^ Last name ^ Social insurance number (enter 9-digit number) ^ Female or Male. ^ Last name at birth (if different from last name above) ^ Mailing address: Apartment number - Street number Street name ^ P.O. Box ^ Rural Route ^ City ^ Province or territory (or country, if outside Canada) ^ Postal code ^ Home address (if different from above): Apartment number - Street number Street name ^ City ^ Province or territory (or country, if outside Canada) ^ Postal code ^ Telephone numbers: Home (including area code) ^ Work (including area code) ^ Information about your new marital status Check (enter an "X") the box that applies to your new marital status. Check "Married" if you have a spouse, or "Living common-law" if you have a common- law partner. We define common-law partner, separated, and spouse on the back of this form. Box 1 Married ^ Box 2 Living common-law ^ Box 3 Widowed ^ Box 4 Divorced ^ Box 5 Separated ^ Enter the date your new marital status began. (If you checked 2 or 5, see the definitions for common-law partner and separated on the back of this form to determine the date you must enter) (Year/Month/Day) ^ If you checked box 1 or 2 above, enter information about your new spouse or common-law partner. First name and initial ^ Last name ^ Social insurance number (enter 9-digit number) ^ Female or Male. ^ If your spouse or common-law partner's address is different from your address, please explain: ^ Certification We cannot process this form unless it is signed. If your new status is married or living common-law, your spouse or common-law partner also needs to sign this form. I certify that the information on this form is, to the best of my knowledge, correct and complete. Sign here ^ It is a serious offence to make a false statement. Date (Year/Month/Day) ^ Spouse or common-law partner's signature ^ It is a serious offence to make a false statement. Date (Year/Month/Day) ^ If you cannot get your spouse or common-law partner's signature, please explain: ^ RC65 E (07) (Back) Canada Child Tax Benefit (CCTB) For information about the CCTB or to get pamphlet T4114, Canada Child Benefits, visit our Web site at www.cra.gc.ca/benefits. You can also get this pamphlet by calling 1-800-959-2221, or get information by calling 1-800-387- 1193. Are you now married or living common-law? We will recalculate your benefit based on the number of children under 18 years of age you have in your care, your province or territory of residence, and your family net income. Note: When we receive notification of your change in marital status, we will recalculate your CCTB taking into consideration your new marital status and your new family net income. We compare the recalculated amount of your CCTB with the original amount to determine which is more beneficial to you. You will receive your payments based on the more beneficial calculation for the remainder of that benefit year. For examples, see pamphlet T4114, Canada Child Benefits. If you or your new spouse or common-law partner have children who are residing with you, we will move all the children to the female parent's account. If you are married or living common-law with a person of the same sex, one of you will receive the CCTB for all the children. To continue receiving the CCTB, you and your spouse or common-law partner have to file your own tax returns every year, even if you have no income to report. Are you now separated, widowed, or divorced? We will recalculate your benefit based on the number of children under 18 years of age you have in your care, your province or territory of residence, and your net income. Goods and services tax/harmonized sales tax (GST/HST) credit For information about the GST/HST credit or to get pamphlet RC4210, GST/HST Credit, visit our Web site at www.cra.gc.ca/benefits. You can also get this pamphlet by calling 1-800-959-2221, or get information by calling 1-800-959- 1953. Are you now married or living common-law? You or your spouse or common-law partner will now get the credit for both of you. We will recalculate the next GST/HST credit payment based on your family net income. Are you now separated, widowed, or divorced? If you did not apply for the GST/HST credit on your last tax return, you can apply now by calling us at 1-800-959-1953, or by including a letter with this form. When applicable, we will recalculate your credit and send you a GST/HST credit notice showing your revised calculation. Marital status definitions Common-law partner This applies to a person who is not your spouse, with whom you are living in a conjugal relationship, and to whom at least one of the following situations applies. He or she: a) has been living with you in a conjugal relationship for at least 12 continuous months; b) is the parent of your child by birth or adoption; or c) has custody and control of your child (or had custody and control immediately before the child turned 19 years of age) and your child is wholly dependent on that person for support. In addition, an individual immediately becomes your common-law partner if you previously lived together in a conjugal relationship for at least 12 continuous months and you have resumed living together in such a relationship. Under proposed changes, this condition will no longer exist. The effect of this proposed change is that a person (other than a person described in b) or c) above) will be your common-law partner only after your current relationship with that person has lasted at least 12 continuous months. This proposed change will apply to 2001 and later years. Reference to "12 continuous months" in this definition includes any period that you were separated for less than 90 days because of a breakdown in the relationship. Separated You are separated when you start living separate and apart from your spouse or common-law partner because of a breakdown in the relationship and this separation lasts for at least 90 days during which time you have not reconciled. Note: Once you have been separated for 90 days (due to a breakdown in the relationship), the effective day of your separated status is the day you started living separate and apart. Spouse This applies only to a person to whom you are legally married. Tax office addresses Send this form to one of the addresses below: Jonquière Tax Centre PO Box 1900 Station LCD Jonquière QC G7S 5J1 Shawinigan-Sud Tax Centre PO Box 3000 Station Main Shawinigan-Sud QC G9N 7S6 St. John's Tax Centre PO Box 12071 Station A St. John's NL A1B 3Z1 Sudbury Tax Services Office PO Box 20000 Station A Sudbury ON P3A 5C1 Summerside Tax Centre 102-275 Pope Road Summerside PE C1N 5Z7 Surrey Tax Centre 9755 King George Highway Surrey BC V3T 5E1 Winnipeg Tax Centre PO Box 14005 Station Main Winnipeg MB R3C 0E3