Christine Submit Cra09

8/3/2019 Christine Submit Cra09

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Do not submit this form - Name: Christine Templeman SIN: 121 511 471 Printed: 2010/03/31

ENCFEDERAL T1 2009Tax Return Enclosures List

Please assemble your return as described below and, where appropriate, sign and date

the indicated forms.

If you are using NETFILE to submit your return, DO NOT MAIL a paper copy of the return

as well. However, be sure to keep all your slips, receipts, and supporting documents for six

years in case CRA selects the return for review.

If you are not using NETFILE, the following instructions apply:

T1 - Income Tax and Benefit Return should be signed on the bottom of page 4.

The following enclosures should be attached to the top left corner of page 3

of the T1 return:

All tax information slips (T4, T3, T5, T4E, etc.)

Official RRSP receipts (if photocopy, must be certified as true copy by issuer)

Charitable donation receipts (including all e-receipts)

Schedule 1 - Federal Tax

Schedule 4 - Statement of Investment Income

Schedule 9 - Donations and Gifts

NL428 - Newfoundland and Labrador Tax and Credits

Make sure you attach receipts for all the deductions or credits you are claiming.

Keep all other supporting documents for six years in case the Canada

Revenue Agency requests them.

Additional instructions:

If you have a correct personalized label from the CRA, affix it over

the name and address section on page 1 of the return.

Do not staple together returns of more than one taxpayer

or returns of the same taxpayer for different years.

Note: Do not submit this enclosures list with your return.


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Canada Revenue Agency Agence du revenu du Canada T1 GENERAL 200Income Tax and Benefit ReturnIdentification NL

Information about you

First name Your social insurance number:Christine 121 511 471

Last name Your date of birth:Templeman 1967/06/10

Mailing Address: Your language of correspondence:

Apt. No. Votre langue de correspondance :

No./Street English Franais18 Ways Rd X

PO Box, RR Marital status on December 31, 2009:P.O. Box 1069

City Bonavista 6. Sing

Prov./Terr. Postal codeNL A0C 1B0

Information about your spouse or

common-law partner (if applicable)

His or her SIN:

Information about your residence His/her first name:

Enter his or her net income for 2009 to

Province or territory of residence claim certain credits:

on December 31, 2009: Enter amount of Universal Child Care Benefit

included on line 117 of his or her return:Newfoundland

Enter the amount of Universal Child Care

Province/territory where you currently reside if not Benefit repayment included on line 213

the same as your mailing address above: of his or her return:

Tick this box if he or she wasNL

self-employed in 2009: 1

Province or territory of self-employment:

If this return is for a deceased

If you became or ceased to be a resident of Canada in 2009, person, enter the date of death:

give the date of: entry or departure: Do not use this area

Residency information for tax administration agreementsDid you reside in the Inuit communities of Rigolet, Nain, Hopedale, Makkovik, or Postville, or on Yes 1 No X

Labrador Inuit Lands, on December 31, 2009? For more information, seeHelp.

Elections Canada (see Help)

A) Are you a Canadian citizen? Yes 1 NoXAnswer the following question only if you are a Canadian citizen.

B) As a Canadian citizen, do you authorize the Canada Revenue Agency to give your name,

address, date of birth, and citizenship to Elections Canada to update the National Register of Electors? Yes 1 NoX

Your authorization is valid until you file your next return. Your information will only be used for purposes permitted under the Canada

Elections Actwhich includes sharing the information with provincial/territorial election agencies, Members of Parliament and registered

political parties, as well as candidates at election time.

Goods and services tax/harmonized sales tax (GST/HST) credit applicationSee Help for details.

Are you applying for the GST/HST credit (including any related provincial credit)? Yes 1 NoX

Do not use

this area 172 171


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ame: Christine Templeman SIN: 121 511 471

Please answer the following question:Did you own or hold foreign property at any time in 2009 with a total cost of more than CAN$100,000?

(see "Foreign Income" in Help for details) 266 Yes 1 No 2X

If yes, attach a completed Form T1135.

If you had dealings with a non-resident trust or corporation in 2009, see Help.

As a Canadian resident, you have to report your income from all sources both inside and outside Canada.

Total incomemployment income (box 14 on all T4 slips) 101 0042,746

Commissions included on line 101 (box 42 on all T4 slips) 102 5636,046

Other employment income 104

Old Age Security pension (box 18 on the T4A(OAS) slip) 113

CPP or QPP benefits (box 20 on the T4A(P) slip) 114

Disability benefits included on line 114

box 16 on the T4A(P) slip) 152

Other pensions or superannuation 115

lected split-pension amount (see Help and attach Form T1032) 116

niversal Child Care Benefit (see Help) 117

mployment Insurance and other benefits (box 14 on the T4E slip) 119

axable amount of dividends (eligible and other than eligible) from taxable

Canadian corporations (see the guide and attach Schedule 4) 120 44271

axable amount of dividends other than eligible dividends,

ncluded on line 120, from taxable Canadian corporations 180

nterest and other investment income (attach Schedule 4) 121 80299

et partnership income: limited or non-active partners only (attach Schedule 4) 122

Registered disability savings plan income (see Help) 125

Rental income Gross Net160 126

axable capital gains (attach Schedule 3) 127

upport payments received Total Taxable amount156 128RRSP income (from all T4RSP slips) 129

Other income Specify: 130

elf-employment income (see Help)

Business income Gross Net162 135

Professional income Gross Net164 137

Commission income Gross Net166 139

Farming income Gross Net168 141

Fishing income Gross Net170 143

Workers' compensation benefits (box 10 on the T5007 slip) 144

ocial assistance payments 145

et federal supplements (box 21 on the T4A(OAS) slip) 146

Add lines 144, 145, and 146 147

Add lines 101, 104 to 143, and 147.

This is your total income. 150 2443,317


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Attach your Schedule 1 (federal tax) and Form 428 (provincial or territorial tax)here. Also attach here any other schedules, information slips, forms, receipts,and documents that you need to include with your return.

Net Incomenter your total income from line 150. 150 2443,317

ension adjustment

box 52 on all T4 slips and box 34 on all T4A slips) 206

Registered pension plan deduction (box 20 on all T4 slips and box 32 on all T4A slips) 207

RRSP deduction (see Schedule 7 and attach receipts) 208 005,304

askatchewan Pension Plan deduction (maximum $600) 209

Deduction for elected split-pension amount (see Help and attach Form T1032) 210

nnual union, professional, or like dues (box 44 on all T4 slips, and receipts) 212

niversal Child Care Benefit repayment (box 12 on all RC62 slips) 213

Child care expenses (attach Form T778) 214

Disability supports deduction 215

usiness investment loss

Gross Allowable deduction228 217

Moving expenses 219

upport payments made

Total Allowable deduction230 220

Carrying charges and interest expenses (attach Schedule 4) 221

Deduction for CPP or QPP contributions on self-employment and other earnings

attach Schedule 8) 222

xploration and development expenses (attach Form T1229) 224

Other employment expenses 229

Clergy residence deduction 231

Other deductions Specify: 232

Add lines 207 to 224, 229, 231, and 232. 233 005,304 005,304

Line 150 minus line 233 (if negative, enter "0"). This is your net income before adjustments. 234 2438,013

ocial benefits repayment (if you reported income on line 113, 119, or 146, see Help).se the federal worksheet to calculate your repayment. 235

Line 234 minus line 235 (if negative, enter "0"). If you have a spouse or common-law partner, see Help.

This is your net income. 236 2438,013

Taxable incomeCanadian Forces personnel and police deduction (box 43 on all T4 slips) 244

mployee home relocation loan deduction (box 37 on all T4 slips) 248

ecurity options deductions 249

Other payments deduction

f you reported income on line 147, see line 250 in Help) 250

imited partnership losses of other years 251

on-capital losses of other years 252et capital losses of other years 253

Capital gains deduction 254

orthern residents deductions (attach Form T2222) 255

dditional deductions Specify: 256

Add lines 244 to 256. 257

Line 236 minus line 257 (if negative, enter "0")

This is your taxable income. 260 2438,013

Use your taxable income to calculate your federal tax on Schedule 1 and your provincial orterritorial tax on Form 428.


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Refund or balance owing

et federal tax: enter the amount from line 55 of Schedule 1 (attach Schedule 1, even if the result is "0") 420 293,223

CPP contributions payable on self-employment and other earnings (attach Schedule 8) 421

ocial benefits repayment (enter the amount from line 235) 422

rovincial or territorial tax (attach Form 428, even if the result is "0") 428 402,279

Add lines 420 to 428

This is your total payable. 435 695,502

otal income tax deducted (see Help) 437 778,444

Refundable Qubec abatement 440

CPP overpayment (enter your excess contributions) 448

mployment Insurance overpayment (enter your excess contributions) 450

Refundable medical expense supplement 452

Working Income Tax Benefit (WITB) (attach Schedule 6) 453

Refund of investment tax credit (attach Form T2038(IND)) 454

art XII.2 trust tax credit (box 38 on all T3 slips) 456

mployee and partner GST/HST rebate (attach Form GST370) 457

ax paid by instalments 476

rovincial or territorial credits (attach Form 479 if it applies) 479

Add lines 437 to 479.

These are your total credits. 482 778,444 778,444

Line 435 minus line 482 08)(2,942

Generally, we do not charge or refund a difference of $2 or less.

Refund Balance owing484 082,942 485

Amount enclosed 486

Attach to page 1 a cheque or money order payable to the Receiver General. Your payment is due no later than April 30, 2010.

Direct Deposit - Start or change (see Help)

You do not have to complete this area every year. Do not complete it this year if your direct deposit information has not changed.

Refund, GST/HST credit, WITB advance payments, and any other deemed overpayment of tax To start direct deposit or tochange account information only, attach a "void" cheque or complete lines 460, 461, and 462.

Notes: To deposit your CCTB payments (including certain related provincial or territorial payments) into the same account, also tick

box 463. To deposit your UCCB payments into the same account, also tick box 491.

Branch number Institution number Account number CCTB UCCB

460 461 462 463 49140543 002 0087122 X

(5 digits) (3 digits) (maximum 12 digits)

I certify that the information given on this return and in any documents For professional tax preparers only490

attached is correct, complete, and fully discloses all my income. Name:

Sign here Address:

It is a serious offence to make a false return.

Telephone Date: Telephone:(709)468-7993

Do not use

this area 487 488

Privacy ActPersonal Information Bank number CRA PPU

Canada Revenue Agency Approval # : RC-09


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Federal TaxT1-2009 Schedule

Complete Step 1 to claim your federal non-refundable tax credits, Step 2 to calculate your federal tax on taxable

ncome and Step 3 to calculate your net federal tax.

You must attach a copy of this schedule to your return.

tep 1 Federal non-refundable tax credits (see Help)

asic personal amount claim $10,320 300 0010,320

ge amount (if you were born in 1944 or earlier) (use federal worksheet) (maximum $6,408) 301

pouse or common-law partner amount (if negative, enter "0")

$10,320 minus (his or her net income) 303

mount for an eligible dependant (attach schedule 5) (if negative, enter "0")

$10,320 minus (his or her net income) 305

mount for children born in 1992 or later

Number of children 366 x $2,089 = 367

mount for infirm dependants age 18 or older (use federal worksheet and attach Schedule 5) 306

CPP or QPP contributions:

through employment from box 16 and 17 on all T4 slips (maximum $2,118.60) 308 671,942

on self-employment and other earnings (attach Schedule 8) 310

mployment Insurance premiums (maximum $731.79) 312 79731

Canada employment amount

f you reported employment income on line 101 or line 104) (maximum $1,044) 363 001,044

ublic transit amount 364

Children's fitness amount 365

ome renovation expenses (attach Schedule 12) 368

ome buyers' amount 369

doption expenses 313

ension income amount (see Help) (maximum $2,000) 314

Caregiver amount (use federal worksheet and attach Schedule 5) 315

Disability amount (for self) (claim $7,196 or if you were under age 18, see Help) 316

Disability amount transferred from a dependant (use federal worksheet) 318

nterest paid on your student loans 319

uition, education, and textbook amounts (attach Schedule 11) 323

uition, education, and textbook amounts transferred from a child 324mounts transferred from your spouse or common-law partner (attach Schedule 2) 326

Medical expenses for self, spouse or common-law partner, and your

ependent children born in 1992 or later 330

Minus: $2,011 or 3% of line 236, whichever is less 401,140

Subtotal (if negative, enter "0") (A)

Allowable amount of medical expenses for

ther dependants (attach Schedule 5) (B)331

Add lines (A) and (B). 332

Add lines 1 to 24. 335 4614,038

Multiply the amount on the line above by 15%. 338 772,105

Donations and gifts (attach Schedule 9) 349 45321

Total federal non-refundable tax credits 350 222,427

Go to Step 2 on page 2


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SchedulePage 2

Step 2 Federal tax on taxable incomenter your taxable income from line 260 of your return. 292438,013

more than more thanse the amount on line 29 to determine

which ONE of the following $40,726 but $81,452 but

ou have to complete. $40,726 not more not more more

or less than $81,452 than $126,264 than $126,264the amount on line 29 is:

nter the amount from line 29. 2438,013

ase amount 000 0040,726 0081,452 00126,264

ine 30 minus line 31

cannot be negative) 2438,013

Rate 15% 22% 26% 29%

Multiply line 32 by line 33. 995,701

ax on base amount 000 006,109 0015,069 0026,720

Add lines 34 to 35. 995,701

Step 3 Net federal taxnter the amount from line 36 above. 995,701 37

ederal tax on split income (from line 5 of Form T1206) 424 38

Add lines 37 and 38. 404 995,701 995,701

nter your non-refundable tax credits from line 28. 350 222,427 40

ederal dividend tax credit (see Help) 425 4851 41

Overseas employment tax credit (attach Form T626) 426 42

Minimum tax carry-over (attach Form T691) 427 43

Add lines 40 to 43. 702,478 702,478

Basic federal tax: line 39 minus line 44 (if negative, enter "0") 429 293,223

ederal foreign tax credit (attach Form T2209) 405

ubtotal: Basic federal tax minus foreign tax credits 293,223

Recapture of investment tax credit (attach form T2038(IND))

Federal tax: Subtotal plus recapture of investment tax credit (if negative, enter "0") 406 293,223

ederal logging tax credit

Total federal tax: Federal tax minus logging tax credit (if negative, enter "0") 293,223

otal federal political contributions

attach receipts) 409

Federal political contribution tax credit (see Help) 410 48

nvestment tax credit (attach Form T2038(IND)) 412 49

abour-sponsored funds tax credit

Net cost Allowable credit413 414 50

Add lines 48 to 50. 416

Line 47 minus line 51 (if negative, enter "0")(if you have an amount on line 38 above, see Form T1206) 417 293,223

Working Income Tax Benefit (WITB) advance payments received (box 10 on the RC210 slip) 415

dditional tax on RESP accumulated income payments (attach Form T1172) 418

Net federal tax: add lines 52 to 54.

Enter this amount on line 420 of your return. 420 293,223


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T1-2009 ScheduleStatement of Investment Income

tate the names of the payers below and attach any information slips you received.

ttach a copy of this schedule to your return.

- Taxable amount of dividends (eligible and other than eligible) from taxable

Canadian corporation (see line 120 in Help)

Taxable amount of dividends other than eligible dividends (specify):

Amounts from information slips (see S4-SUPP)

Add lines 1 to 3 and enter this amount on line 180 of your return. 180

Taxable amount of eligible dividends (specify):

Amounts from information slips (see S4-SUPP) 44271

Add lines 4 to 7 and enter this amount on line 120 of your return. 120 44271

- Interest and other investment income (see line 121 in Help)

Specify:

Amounts from information slips (see S4-SUPP) 80299

Income from foreign sources:

Amounts from information slips (see S4-SUPP)

Enter this amount on line 121 of your return. 121 80299

I - Net partnership income (loss) (see line 122 in Help)

Amounts from T5013 slips

Enter this amount on line 122 of your return. 122

V - Carrying charges and interest expenses (see line 221 in Help)

Amounts from T5013 slips

Interest on money borrowed to earn interest, dividend and royalty income

Interest on money borrowed to acquire an interest in a limited partnership

or a partnership in which you are not an active partner

Enter this amount on line 221 of your return. 221


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S4-SU

Schedule 4 - Supplementary StatementInvestment Income From Information Slips

Other Than Eligible Interest and Foreign

Eligible Dividends Dividends Other Sources

T5: Scotiabank 23107

T5: canada savings bonds 57192

T5: sun life financial 44271

TOTAL 44271 80299


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T1-2009 ScheduleDonations and Gifts

Attach a copy of this schedule to your return along with the official receipts that support your claim. Remember, you may have

charitable donations shown on your T4 and T4A slips. See Help for more information.

Total eligible amount of charitable donations and government gifts 001,205

Enter your net income from line 236 of your return. x 75% =2438,013 9328,509

Note: If the amount on line 1 is less than the amount on line 2, enter the amount from line 1 on line 340 below and continue

completing the schedule from line 340.

Gifts of depreciable property (see Help) 3337

Gifts of capital property (see Help) 4339

Add lines 3 and 4. x 25% =

Total donations limit: add lines 2 and 5

(not to exceed the amount on line 236 of your return) 9328,509

Allowable charitable donations and government gifts

(enter the amount from line 1 or line 6, whichever is less) 340 001,205

Eligible amount of cultural and ecological gifts

(see line 349 in Help) 342

Add lines 340 and 342. 344 001,205

Enter $200, or the amount from line 344, whichever is less. x 15% =345 00200 346 0030

Line 344 minus line 345 x 29% =347 001,005 348 45291

Donations and gifts: add lines 7 and 8.

Enter this amount on line 349 of Schedule 1. 45321


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NLT1 General -

Newfoundland and Labrador Tax and Credits

Complete this form and attach a copy of it to your return. For details, see Help.

Step 1 - Newfoundland and Labrador non-refundable tax creditsFor internal use only 5600

asic personal amount claim $7,778 15804 007,778

ge amount (if born in 1944 or earlier) (maximum $3,655) 25808

pouse or common-law partner amount

Base amount 006,992

Minus: his or her net income

(maximum $6,356)Result: (if negative, enter "0") 35812

mount for an eligible dependant 45816

mount for infirm dependants age 18 or older 55820

Canada Pension Plan or Qubec Pension Plan contributions:

(amount from line 308 of your federal Schedule 1) 65824 671,942

(amount from line 310 of your federal Schedule 1) 75828

mployment Insurance premiums (amount from line 312 of your federal Schedule 1) 85832 79731

doption expenses 95833

ension income amount (maximum $1,000) 105836

Caregiver amount 115840

Disability amount (for self) 125844

Disability amount transferred from a dependant 135848

nterest paid on your student loans (amount from line 319 of your federal Schedule 1) 145852

our tuition and education amounts [attach Schedule NL(S11)] 155856

uition and education amounts transferred from a child 165860

mounts transferred from your spouse or

ommon-law partner [attach Schedule NL(S2)] 175864

Medical expenses from line 330 of your federal Schedule 1 185868

Enter $1,694 or 3% of net income

from line 236 of your return, whichever is less. 19401,140

Line 18 minus line 19 (if negative, enter "0") 20

llowable amount of medical expensesor other dependants (see Help) 215872

dd lines 20 and 21. 225876

dd lines 1 to 17 and 22, plus line 8 of RC269. 5880 4610,452 4610,452

on-refundable tax credit rate 7.7%

Multiply line 23 by line 24. 5884 84804

Donations and gifts:

Amount from line 345 of your federal Schedule 9 x 7.7% = 2600200 4015

Amount from line 347 of your federal Schedule 9 x 15.5% = 27001,005 78155

dd lines 26 and 27. 5896 18171 18171

dd lines 25 and 28.

nter this amount on line 41. Newfoundland and Labrador non-refundable tax credits 6150 02976

Go to Step 2

on the next page


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NLPage

Step 2 Newfoundland and Labrador tax on taxable income

nter your taxable income from line 260 of your return. 2438,013

se the amount at line 30 to determine which ONE of the If line 30 is

ollowing columns you have to complete. If line 30 is more than $31,061, but If line 30 is more

$31,061 or less not more than $62,121 than $62,121

nter the amount from line 30 in the applicable column. 31 312438,013

32 32000 0031,061 0062,121

ine 31 minus line 32 (cannot be negative) 33 33246,952

7.7% 34 12.8% 34 15.5%

Multiply line 33 by line 34. 35 3589889

36 36000 002,392 006,367

Newfoundland and Labrador

dd lines 35 and 36. tax on taxable income 37 37893,281

Go to Step 3 Go to Step 3 Go to Step 3

Step 3 - Newfoundland and Labrador tax

nter your Newfoundland and Labrador tax on taxable income from line 37. 893,281

nter your Newfoundland and Labrador tax on split income from Form T1206. 6151

dd lines 38 and 39. 893,281

nter your Newfoundland and Labrador non-refundable tax credits from line 29. 4102976

L dividend tax credit:

Credit calculated 426152 4726

L overseas employment tax credit:

Amount from line 426 of federal Schedule 1 x 51.3% = 436153

L minimum tax carryover:

Amount from line 427 of federal Schedule 1 x 51.3% = 446154

dd lines 41 to 44. 491,002 491,002

ine 40 minus line 45 (if negative, enter "0") 402,279

L additional tax for minimum tax purposes:

Amount from line 117 of Form T691 x 51.3% =dd lines 46 and 47. 402,279

nter the provincial foreign tax credit from Form T2036.


olitical contribution tax credit

ewfoundland and Labrador political contributions made in 2009 516175

Credit calculated for line 52 on the Provincial Worksheet (maximum $500)


abour-sponsored venture capital tax credit

nter the credit amount from the Certificate(s) NL LSVC-1 (see Help). 6176ine 53 minus line 54 (if negative, enter "0") 402,279

Direct equity tax credit

nter the direct equity tax credit from Form T1272.


L resort property investment tax credit

nter the resort property investment tax credit from Form T1297.


Continue on the next pag


13/16


NLPage

Step 3 - Newfoundland and Labrador tax (continued)

ewfoundland and Labrador low-income tax reduction

you had a spouse or common-law partner on December 31, 2009, you have to agree on who will claim this tax reduction.

Only one of you can claim it for your family. However, any unused amount can be claimed by the other person.

nter the amount from line 59 on the previous page. 402,279

Check this box to claim the tax reduction on your returnX

nused low-income tax reduction from your spouse or common-law partner, if applicable 6186


f you claimed an amount on line 61, enter "0" on line 79.)

Adjusted family income for the calculation of the Column 1 Column 2

Newfoundland and Labrador low-income tax reduction You Your spouse or

common-law

partner

Enter the net income amount from line 236 of the return. 632438,013

Total of the Universal Child Care Benefit repayment (line 213 of the return) and the

registered disability savings plan income repayment (included on line 232) 64

Add lines 63 and 64. 652438,013

Total of the Universal Child Care Benefit income (line 117 of the return) and the

registered disability savings plan income (line 125 of the return) 66

Line 65 minus line 66 (if negative, enter "0") 672438,013

Add the amounts on line 67 in column 1 and column 2, if applicable.

Enter the amount on line 74 below. Adjusted net family income 2438,013

nter the amount from line 62 above. 402,279

asic reduction claim $558 706187 00558

Reduction for your spouse orommon-law partner claim $280 716188

Reduction for an eligible dependant

aimed on line 5816 claim $280 726189

dd lines 70, 71, and 72. (maximum $838) 7300558

Adjusted family income

nter the amount from line 68 above. 742438,013

you claimed an amount on lines 71 or 72,

nter $26,625; otherwise, enter $15,911. 750015,911


pplicable rate 16% 77

Multiply line 76 by line 77. 78363,536 363,536

ine 73 minus line 78 Newfoundland and Labradorf negative, enter "0") low-income tax reduction

ine 69 minus line 79 (if negative, enter "0")

nter the result on line 428 of your return. Newfoundland and Labrador tax 402,279

Unused low-income tax reduction that can be claimed by your spouse or common-law partner

Amount from line 79

Amount from line 60 402,279

Line 81 minus line 82 (if negative, enter "0") Unused amount


14/16


Direct Deposit Request - Individuals T1-DD (se this form to start direct deposit the following amounts:

. your income tax refund, goods and services tax/harmonized sales tax credit (GST/HST) including certain related provincial payments,Working Income Tax Benefit advance payments (WITB), and any other deemed overpayment of tax to which you are entitled or to which

you may become entitled;

. your Canada Child Tax Benefit (CCTB) payments including certain related provincial and territorial payments; and

. your Universal Child Care Benefit payments.lso use this form to change information you already provided to the Canada Revenue Agency. See Help for more information.

IdentificationFirst name and initial Last name Your SIN

Christine Templeman 121 511 471

Mailing address: Apt. No. - Street No. Street name

Is this a new address?18 Ways Rd

PO Box Yes 1 No 2X

If yes, enterP.O. Box 1069

City Prov./Terr. Postal code the date you moved.

Bonavista NL A0C 1B0

Check the box(es) below to show your choice(s).

Income tax refund, GST/HST credit, WITB advance payments, and any other deemed overpayment of tax

Check this box to have your income tax refund, GST/HST credit, WITB advance payments, and any other deemed overpayment of taxX

deposited into your bank account held in Canada. Attach a blank cheque with the banking information encoded on it and write "VOID"

across the front, or complete the banking information area below (see the example in Help).

Branch number Institution number Account number


460 461 46240543 002 0087122

Canada Child Tax Benefit (CCTB)463 Check this box to have your CCTB payments deposited into the same bank account held in Canada as your income tax refund,X

GST/HST credit, WITB advance payments, and any other deemed overpayment of tax.

Check this box to have your CCTB payments deposited into a different bank account held in Canada.

Attach a blank cheque with the banking information encoded on it and write "VOID - CCTB" across the

front, or complete the banking information area below (see the example in Help).



471 472 473

Universal Child Care Benefit (UCCB)491 Check this box to have your UCCB payments deposited into the same bank account held in Canada as your income tax refund,

GST/HST credit, WITB advance payments, and any other deemed overpayment of tax.

492 Check this box to have your UCCB payments deposited into the same bank account held in Canada as your CCTB payments.

Check this box to have your UCCB payments deposited into a different bank account held in Canada.

Attach a blank cheque with the banking information encoded on it and write "VOID - UCCB" across the

front, or complete the banking information area below (see the example in Help).



493 494 495

CertificationI, as the person entitled to receive the payments, authorize the Receiver General to deposit the payments described above into the above-noted bank

account(s) until further notice.

Signature Telephone number Date


15/16


OTH

Other Income, Deductions and Credits

Other Income - Line 130

T4A - Box 18: Lump sum payments

T4A - Box 24: Annuities (non-qualifying)

T4A - Box 26: Eligible retiring allowances

T4A - Box 27: Non-eligible retiring allowances

T4A - Box 28: Other income - Scholarships

Less: Tax exemption

Taxable portion of scholarships =

T4A - Box 28: Revoked Deferred Profit Sharing Plan

T4A - Box 28: Disability benefits from a superannuation or pension plan

T4A - Box 28: Tax deferred cooperative share

T4A - Box 28: Apprenticeship incentive or completion grant

T4A - Box 28: Variable pension benefits

T4A - Box 28: Periodic payments from an unregistered plan

T4A - Box 28: Tax-Free Savings Account (TFSA) taxable amount

T4A - Box 28: Other income - Other

T4A - Box 30: Patronage allocations due to business purchases

T4A - Box 40: RESP accumulated income payments

T4A - Box 42: RESP educational assistance payments

T4A-RCA - Statement of distribution from an RCA

T3 - Box 22: Lump sum pension benefits

T3 - Box 25: Foreign non-business income - Other

T3 - Box 26: Other income

T4A - Box 28: Other income - Death benefits

T3 - Box 35: Eligible death benefits +

Less: Tax exemption

Taxable portion of death benefits =

T4RIF - Box 16: Taxable amounts (non-qualifying)

T4RIF - Box 18: Deemed receipt by annuitant - Deceased

T4RIF - Box 20: Deemed receipt by annuitant - Deregistration

T4RIF - Box 22: Other income

T5013 - Box 30: Other incomeNegative balances from Canadian resource expenditure pools (form T1229)

Other income from foreign slips

Other:

Total Other Income - to line 130 of your return

Other Deductions - Line 232

Undeducted and excess RRSP contributions (line 11, Form T746)

Undeducted RRSP contributions withdrawn (using form T3012A)

Legal/Acctg. exp. to appeal income tax assess. or respond to CRA reviews

Legal expenses relating to support paymentsDeduction under section 20(11)

Deduction under section 20(12)

Canada or Qubec pension plan benefits paid back

Old age security paid back (Box 20 of T4A(OAS) slip)

Net federal supplements paid back

Employment insurance benefits paid back (Box 30 of T4E slip)

Registered disability savings plan (RDSP) income repayment

Scholarships paid back

Shareholder's loan amounts paid back

Continued on page 2


16/16


OTH

Page 2

Other Deductions - Line 232, continued

Canadian motion picture film and videotape write-offs

RCA deductions under subsection 60(t) and 60(u)

Split income of a child under 18 (from Form T1206)

T4RIF - Box 22: Other deductions

T4RSP - Box 28: Other deductions

Depletion allowances (from Form T1229)

Post-death decrease in the value of an unmatured RRSP or a RRIF

Other:

Total Other Deductions - to line 232 of your return

Additional Deductions - Line 256

Non-taxable tuition assistance (Box 21 of T4E slip)

Vow of perpetual poverty

Exempt portion (15%) of U.S. social security benefits

Other income exempt under a tax treaty

Other income exempt under a tax treaty - from slips

Employment with a prescribed international organization

Other:

Total Additional Deductions - to line 256 of your return

Total Income Tax Deducted - Line 437

From all information slips 778,444Plus T1032 line N - pension transferee

Subtotal 778,444

Less T1032 line N - pensioner

Total 778,444

Documents

Christine Submit Cra09