Tax Court of Canada
Notice of Appeal – Informal Procedure
Please Print in Ink
Type of appeal
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TCC USE ONLY
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Customs Act
Income Tax Act
Appeal No.:
Excise Act, 2001
Excise Tax Act (GST)
Taxation Year(s) or Assessment Number(s)
(For an Excise Tax (GST) appeal, indicate the period
of assessment and the assessment number)
Date of Reassessment, Confirmation
or Decision from the Canada Revenue Agency
Name and Address of Appellant
If You Are Not Representing Yourself,
Please Complete the Following
Mr.
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Mrs.
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Ms.
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Miss
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Name of representative
Name and Surname of individual or company name
Name of firm if applicable
Address
City
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Province
Postal Code
City
Telephone Number(s):
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Home
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Address
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)
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Province
Postal Code
Type of Representation
Work
)
Lawyer
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Accountant
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Other
Fax
E-mail address (if applicable)
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I ELECT TO HAVE THE INFORMAL
Other, please specify:
Telephone Number(s)
PROCEDURE APPLY TO THIS APPEAL
(
)
Home
(
)
Fax
E-mail address (if applicable)
see reverse
(
Work
)
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Statement of relevant facts and reasons in support of your appeal in which you say why you disagree with the Canada Revenue Agency’s decision
(use another sheet, if required) .
Date
Signature