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R certain persons who acquired citizenship on April 17, 2009) 3(1)(g) Return original document(s) Approved Signature and renunciation effective date Date Y M D Notify: Send to: Before you start, read the instructions Please PRINT in ink or TYPE FOR OFFICIAL USE ONLY Protected when completed 1 I want service in English OR French 2 Have you ever had a certificate of Canadian No Yes Certificate Number citizenship or naturalization? My certificate of Canadian citizenship is: en.

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