DETERMINATION OF RESIDENCY STATUS (ENTERING CANADA) ț Complete all areas of this form if you entered or stayed briefly in Canada. Give all the facts about your residency status while living in and outside Canada. ț Mail only one completed copy of this form for the tax years in question (an additional form is not necessary for each tax year unless your situation changes, or directed otherwise) to the International Tax Services Office, 2204 Walkley Road, Ottawa ON K1A 1A8. If you prefer, you can send the form by fax to
613-941-2505.
ț If you need help completing this form, see Interpretation Bulletin IT-221, Determination of an Individual's Residence Status, or call the International Tax
Services Office at:
Calls from within the Ottawa area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 613-952-3741
Calls from other areas in Canada and the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-267-5177
Calls from outside Canada and the United States (we accept collect calls) . . . . . . . . . . . . . . . . . . . . . . 613-952-3741 ț You can find most forms and publications, as well as information on taxes, programs and credits, at our www.cra.gc.ca Web site.
Attach any necessary additional information to this form.
Identification
Last name

Usual first name and initial

Social insurance number (SIN)

Canadian address

Tax year

Telephone number

Do you want us to change our records to show this as your mailing address for all future correspondence?

Yes

In what province will you reside?

No

Mailing address ONLY (if different from above)

Citizenship

Date of entry

Date of birth

Marital status
Married

DD

MM

Living common-law

Widowed

Divorced

YYYY

Separated

Single

DD

MM

YYYY

Length of stay
How long do you expect to live in Canada?
Number of days:

Number of months:

Number of years:

When will you leave Canada? (if applicable)
Entered Canada permanently and have no plan to leave Canada.

General Information
Tick (✔) the box that applies to you:
You usually live in another country and you will be temporarily living in Canada for number of days if you give us the dates you will be in Canada).

days in the year, but will leave Canada during the year (we will calculate the

You usually live in another country, but enter and leave Canada on the same day to work, shop, or study.
You usually live in Canada, but you leave Canada during the day to work, shop, or study in another country, and return to Canada the same day.
You have permanent resident (landed immigrant) status.
DD

MM

YYYY

You have applied for permanent resident (landed immigrant) status. Give the date of application:
You have been given permission by Citizenship and Immigration Canada to stay in Canada for an extended period.
You have a visa that allows you to be in Canada temporarily. Give the following information:
The type of visa you have:
Do you plan to renew it?

Visa expiry date:
Yes

No

We may ask you to give us a copy of the document from Citizenship and Immigration Canada that allows you to stay in Canada.
None of the above – explain:

Living outside Canada
Tick (✔) a box to indicate the reason you were living outside Canada:
You were a member of the Canadian Forces.
You were a member of the overseas Canadian Forces school staff who filed income tax returns as a resident of Canada.
You were a locally engaged employee (you lived outside of Canada after severing ties and were then hired locally) of a Canadian embassy or mission abroad.
NR74 E (04)

You were an ambassador, a high commissioner, an agent general of a province or territory of Canada, or an officer or servant (employee) of Canada or of a province or territory of Canada.
Did you receive a representation allowance for the year? . . . . . . . . . . . . . . . . . . . . . . . . . . .