RRSP's, The Tax Treaty, The Mess (Information supplied on this topic is from experience only, and in no way reflects policies, regulations, or laws from either Canada, USA, Manitoba, or Minnesota).  Even though I have researched this topic for hundreds of hours, do NOT treat the below as professional advice.  I think you will find the below information, however, to be quite accurate. (Revised EXTENSIVELY on March, 2003)

Distribution Taken:
The below is an example election, created on a single white sheet of 8 1/2 x 11 paper:
 

Johnny Q. Canuck SSN: 468-12-3456 Statement pursuant to IRS Revenue Procedure 2002-23 I am claiming benefit of Article XVIII(7) of the US-Canada Income Tax Convention with respect to the following Registered Retirement Savings Plan (RRSP):  Trustee: Account Numbers: Balance on January 1, 2002: The Big RRSP Group 1235 Portage Avenue Winnipeg MB R3R 3R3 CANADA 12345678 US$ 12,443.56  CDN$ 19,445.67 Total Income Deferred by Article XVIII(7) on this account: US$ 1,202.49 Note this plan was transferred to another account at Second-Rate Securities on Dec. 2, 2002 and is now closed.