T1 GENERAL 2011 Income Tax and Benefit Return

Transcription

1 Canada Revenue Agence du revenu Agency du Canada T1 GENERAL 2011 Income Tax and Benefit Return Complete all the sections that apply to you in order to benefit from amounts to which you are entitled. Identification First name and initial Ima Last name Busy Single-Mom Care of Mailing address: Apt No Street No Street name 1777 Lynndale Blvd PO Box RR City Prov./Terr. Postal Code Stoney Creek ON L8V 1E5 Enter your province or territory of residence on December 31, 2011: Information about your residence Ontario Information about you Enter your social insurance number (SIN) Enter your date of birth: ON Year/Month/Day 1975/02/03 Your language of correspondence: English Français Votre langue de correspondance : X Your marital status on December 31, 2011 (see the "Marital status" section in the guide for details) 1 Married 2 Living common-law 3 Widowed 4 Divorced 5 X Separated 6 Single Information about your spouse or common-law partner (if you ticked box 1 or 2 above) Enter his or her social insurance number: Enter his or her first name: Enter his or her net income for 2011 to claim certain credits: 7 Enter the province or territory where you currently reside if it is not the same as your mailing address above: If you were self-employed in 2011, enter the province or territory of self-employment: If you became or ceased to be a resident of Canada for income tax purposes in 2011, enter the date of: Month/Day Month/Day entry or departure Enter the amount of UCCB included on line 117 of his or her return: Enter the amount of UCCB repayment included on line 213 of his or her return Tick this box if he or she was self-employed in 2011: 1 Person deceased in 2011 If this return is for a deceased person, enter the date of death: Do not use this area Year/Month/Day Do not use this area

2 2 Elections Canada (see the Elections Canada page in the tax guide for details or visit A) Are you a Canadian citizen? Yes X 1 No 2 Answer 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 X 1 No 2 Your authorization is valid until you file your next return. Your information will only be used for purposes permitted under the Canada Elections Act which 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 application See the guide for details. Are you applying for the GST/HST credit or the Ontario Sales Tax Credit? Yes 1 No X 2 Please answer the following question Did you own or hold foreign property at any time in 2011 with a total cost of more than CAN$100,000? (see the "Foreign income" section in the guide for details) 266 Yes 1 No X 2 If yes, complete and attach Form T1135 to your return. If you had dealings with a non-resident trust or corporation in 2011, see the "Foreign income" section in the guide.

3 Your guide contains valuable information to help you complete your return. When you come to a line on the return that applies to you, look up the line number in the guide for more information. 3 As a Canadian resident, you have to report your income from all sources both inside and outside Canada. Total income Employment income (box 14 on all T4 slips) Commissions included on line 101 (box 42 on all T4 slips) , 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 Elected split-pension amount (attach Form T1032) Universal Child Care Benefit (UCCB) UCCB amount designated to a dependant 185 1, Employment Insurance and other benefits (box 14 on the T4E slip) 119 Taxable amount of dividends (eligible and other than eligible) from taxable Canadian corporations (attach Schedule 4) 120 Taxable amount of dividends other than eligible dividends, included on line 120, from taxable Canadian corporations 180 Interest and other investment income (attach Schedule 4) 121 Net partnership income: limited or non-active partners only (attach Schedule 4) 122 Registered disability savings plan income 125 Rental income Gross 160 Net 126 Taxable capital gains (attach Schedule 3) 127 Support payments received Total , Taxable amount 128 6, RRSP income (from all T4RSP slips) 129 Other income Specify: 130 Self-employment income Business income Gross 162 Net 135 Professional income Gross 164 Net 137 Commission income Gross 166 Net 139 Farming income Gross 168 Net 141 Fishing income Gross 170 Net 143 Workers' compensation benefits (box 10 on the T5007 slip) Social assistance payments Net federal supplements (box 21 on the T4A(OAS) slip) 146 Add lines 144, 145, and 146 (see line 250 in the guide). 147 Add lines 101, 104 to 143, and 147 This is your total income ,

4 Attach your Schedule 1, Federal Tax here. Also attach here any other schedules, information slips, forms, receipts, and documents that you need to include with your return. 4 Net income Enter your total income from line 150 Pension adjustment (box 52 on all T4 slips and box 034 on all T4A slips) 206 9, , Registered pension plan deduction (box 20 on all T4 slips and box 032 on all T4A slips) RRSP deduction (see Schedule 7 and attach receipts) 207 4, Deduction for elected split-pension amount (attach Form T1032) 210 Annual union, professional, or like dues (box 44 on all T4 slips, and receipts) 212 1, Universal Child Care Benefit repayment (box 12 on all RC62 slips) 213 Child care expenses (attach Form T778) 214 1, Disability supports deduction 215 Business investment loss Gross 228 Allowable deduction 217 Moving expenses 219 Support payments made Total 230 Allowable deduction 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) Exploration and development expenses (attach Form T1229) Other employment expenses Clergy residence deduction Other deductions Specify: See schedule 232 1, Add lines 207 to 224, 229, 231, and , , Line 150 minus line 233 (if negative, enter "0"). This is your net income before adjustments , Social benefits repayment (if you reported income on line 113, 119, or 146, see Line 235 in the guide) Use 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 Line 236 in the guide. This is your net income , Taxable income Canadian Forces personnel and police deduction (box 43 on all T4 slips) Employee home relocation loan deduction (box 37 on all T4 slips) Security options deductions Other payments deduction (if you reported income on line 147, see Line 250 in the guide) Limited partnership losses of other years Non-capital losses of other years Net capital losses of other years Capital gains deduction Northern residents deductions (attach Form T2222) Additional deductions Add lines 244 to 256. Specify: Line 236 minus line 257 (if negative, enter "0") This is your taxable income , Use your taxable income to calculate your federal tax on Schedule 1 and your provincial or territorial tax on Form 428.

5 Refund or Balance owing 5 Net federal tax: enter the amount from line 58 of Schedule 1 (attach Schedule 1, even if the result is "0") CPP contributions payable on self-employment and other earnings (attach Schedule 8) Employment Insurance premiums payable on self-employment and other eligible earnings (attach Schedule 13) Social benefits repayment (enter the amount from line 235) 420 5, Provincial or territorial tax (attach Form 428, even if the result is "0") 428 3, Add lines 420, 421, 430, 422, and 428. This is your total payable , Total income tax deducted Refundable Québec abatement CPP overpayment (enter your excess contributions) Employment Insurance overpayment (enter your excess contributions) Refundable medical expense supplement (use the federal worksheet) Working Income Tax Benefit (WITB) (attach Schedule 6) Refund of investment tax credit (attach Form T2038(IND)) Part XII.2 trust tax credit (box 38 on all T3 slips) , Employee and partner GST/HST rebate (attach Form GST370) 457 Tax paid by instalments 476 Provincial or territorial credits (attach Form 479) Add lines 437 to 479. These are your total credits , , Line 435 minus line 482 This is your refund or balance owing. (1,507 35) Refund If the result is negative, you have a refund. If the result is positive, you have a balance owing. Enter the amount below on whichever line applies. Generally, we do not charge or refund a difference of $2 or less , Balance owing (see line 485 in the guide) 485 Direct deposit - Start or change (see line 484 in the guide) You do not have to complete this area every year. Do not complete it this year if your direct deposit information has not changed. Income tax refund, GST/HST credit, WITB advance payments, and any other deemed overpayment of tax To start direct deposit or to change account information, complete lines 460, 461, and 462 below. 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 Institution number number Account number CCTB UCCB (5 digits) (3 digits) (maximum 12 digits) Amount enclosed Attach to page 1 a cheque or money order payable to the Receiver General, or make your payment online (go to Your payment is due no later than April 30, Ontario Opportunities Fund You can help reduce Ontario's debt by completing this area to donate some or all of your 2011 refund to the Ontario Opportunities Fund. Please see the provincial pages for details. Amount from line 484 above 1, Your donation to the Ontario Opportunities Fund Net refund (line 1 minus line 2) 466 1, I certify that the information given on this return and in any documents attached is correct, complete, and fully discloses all my income. Sign here It is a serious offence to make a false return. Telephone(905) Date2012/02/ X Name Address Telephone For professional tax preparers only CIC Financial Group 114 Wilson St W Ancaster, Ontario L9G 1N3 (905) Do not use this area Privacy Act, Personal Information Bank number CRA PPU 005 RC

6 T Federal Tax Schedule 1 Complete this schedule, and attach a copy to your return. For more information, see the related line in the guide. Step 1 - Federal non-refundable tax credits Basic personal amount claim $10, , Age amount (if you were born in 1946 or earlier) (use federal worksheet) (maximum $6,537) Spouse or common-law partner amount: (if negative, enter "0") $ 10,527 minus ( 0 00 his or her net income from page 1 of your return) = Amount for an eligible dependant (attach schedule 5) (if negative, enter "0") $ 10,527 minus ( 0 00 his or her net income) = , Amount for children born in 1994 or later Number of children x $2,131 =367 4, Amount for infirm dependants age 18 or older (use federal worksheet and attach Schedule 5) CPP or QPP contributions: through employment from box 16 and box 17 of all T4 slips (maximum $2,217.60) 308 2, on self-employment and other earnings (attach Schedule 8) Employment Insurance premiums: through employment from box 18 and box 55 of all T4 slips 310 (maximum $786.76) on self-employment and other eligible earnings (attach Schedule 13) Volunteer firefighters' amount Canada employment amount (If you reported employment income on line 101 or line 104, see line 363 in the guide.) (maximum $1,065) 363 1, Public transit amount Children's fitness amount Children's arts amount Home buyers' amount Adoption expenses Pension income amount (use the federal worksheet) Caregiver amount (use the federal worksheet and attach Schedule 5) (maximum $2,000) Disability amount (for self) (Claim $7,341 or if you were under age 18, use the federal worksheet) Disability amount transferred from a dependant (use the federal worksheet) Interest paid on your student loans Your tuition, education, and textbook amounts (attach Schedule 11) Tuition, education, and textbook amounts transferred from a child Amounts transferred from your spouse or common-law partner (attach Schedule 2) Medical expenses for self, spouse or common-law partner, and your dependent children born in 1994 or later Minus: $2,052 or 3% of line 236, whichever is less Subtotal (if negative, enter "0") Allowable amount of medical expenses for other dependants (see the calculation at line 331 in the guide and attach Schedule 5) , , , B Add lines A and B. 2, , Add lines 1 to , Federal non-refundable tax credit rate 15 % 28 Multiply line 27 by line , Donations and gifts (attach Schedule 9) Add lines 29 and 30. Enter this amount on line 43. Total federal non-refundable tax credits 350 4, A Page 1 of 2

7 Step 2 - Federal tax on taxable income Enter your taxable income from line 260 of your return. 60, Complete the appropriate column depending on the amount on line 32. Line 32 is $41,544 or less Line 32 is more than $41,544 but not more than $83,088 Line 32 is more than $83,088 but not more than $128,800 Line 32 is more than $128,800 Enter the amount from line , , , , Line 33 minus line 34 (cannot be negative) , x 15 % x 22 % x 26 % x 29 % 36 Multiply line 35 by line 36. 4, , , , Add lines 37 and , Go to Step 3. Go to Step 3. Go to Step 3. Go to Step 3. Step 3 - Net federal tax 39 Enter the amount from line 39 10, Federal tax on split income (from line 5 of Form T1206) Add lines 40 and , , Enter your non-refundable tax credits from line , Federal dividend tax credit Overseas employment tax credit (attach Form T626) Minimum tax carryover (attach Form T691) Add lines 43 to 46. 4, , Line 42 minus line 47 (if negative, enter "0"). Basic federal tax 429 5, Federal foreign tax credit (attach Form T2209) Federal logging tax credit Line 48 minus line 49 (if negative, enter "0"). Federal tax 406 5, Total federal political contributions (attach receipts) Federal political contribution tax credit (use the federal worksheet) Investment tax credit (attach Form T2038(IND)) (maximum $650) Labour-sponsored funds tax credit Net cost 413 Allowable credit Add lines 51, 52 and Line 50 minus line 54 (if negative, enter "0") If you have an amount on line 41 above, see Form T , Working Income Tax Benefit (WITB) advance payments received (box 10 on the RC210 slip). Additional tax on RESP accumulated income payments (attach Form T1172) Add lines 55, 56, and 57. Enter this amount on line 420 of your return. Net federal tax 420 5, Privacy Act, Personal Information Bank number CRA PPU 005 Page 2 of 2

8 T Details of Dependant Schedule 5 See the guide to find out if you can claim an amount on line 305, 306, 315, and/or 331 of Schedule 1. For each dependant claimed, provide the details requested below. Attach a copy of this schedule to your return. Line 305 Amount for an eligible dependant Month/Day If your marital status changed in 2011, enter the date of the change. Do not forget to check the box on page 1 of your return to state your marital status on December 31, Last name Busy First name Johnny 1777 Lynndale Blvd, Date of birth Address Stoney Creek ON L8V1E5 2003/10/01 Relationship to you Son Net income in 2011 Nature of the infirmity (if it applies) Amount of claim 10, Line 306, 315, or 331 Last name Year of birth Relationship to you Net income in 2011 Nature of the infirmity (if it applies) Line claimed Amount of claim First name Address N/A Privacy Act, Personal Information Bank number CRA PPU 005 Page 1 of 1

9 T RRSP Unused Contributions, Schedule 7 Transfers, and HBP or LLP Activities Generally, Saskatchewan Pension Plan (SPP) contributions are subject to the same rules as RRSP contributions. For more information about the SPP, visit Complete this schedule, and attach it to your return only when one or more of the following situations applies: You will not be deducting on your return for 2011 all of the unused RRSP contributions, amount (B) of "Your 2011 RRSP Deduction Limit Statement" shown on your latest notice of assessment, notice of reassessment, or T1028, Your RRSP Information for You will not be deducting on your return for 2011 all of the RRSP contributions you made from March 2, 2011, to February 29, You have transferred to your RRSP certain amounts you included in your income. You are designating contributions made to your RRSP as a 2011 repayment under the Home Buyer's Plan (HBP) or the Lifelong Learning Plan (LLP). You withdrew funds from your RRSP in 2011 under the HBP or the LLP. (You cannot withdraw funds from your SPP under the HBP or the LLP.) If none of these situations apply to you, do not complete this schedule, and only enter your total RRSP contributions on line 208 of your return. For more information, see line 208 in the guide. PART A Contributions Unused RRSP contributions: amount (B) of "Your 2011 RRSP Deduction Limit Statement" shown on your latest notice of assessment, notice of reassessment, or T1028, Your RRSP Information for Total contributions* made to your RRSP or your spouse or common-law partner's RRSP from: March 2, 2011, to December 31, 2011 (attach all receipts) January 1, 2012, to to February 29, 2012 (attach all receipts) Add lines 2 and Add lines 1 and 4. Total RRSP contributions * Include your transfers and contributions that you are designating as a repayment under the HBP or LLP. See Line 208 in the guide for the list of contributions to exclude. PART B Repayments under the HBP and the LLP Specify the contributions made to your RRSP from January 1, 2011, to February 29, 2012, that you are designating as your repayments under the HBP and LLP for Do not include an amount you deducted or designated as a repayment on your 2010 return, or that was refunded to you. Also, do not include any contributions or transfers that you will be including on line 10 or 11 below. Repayment under the HBP Repayment under the LLP Add lines 6 and PART C RRSP deduction Line 5 minus line 8 RRSP contributions available to deduct RRSP contributions you are deducting for 2011 (this amount cannot exceed the lesser of the amount on line 9, excluding transfers, and your RRSP deduction limit for 2011, shown at amount (A) of "Your 2011 RRSP Deduction Limit Statement" shown on your latest notice of assessment, notice of reassessment, or T1028, Your RRSP Information for 2011) 10 Transfers (see "Line 11 - Transfers" at Line 208 in the guide) Add lines 10 and Enter the amount from line 9 or line 12, whichever is less Also enter this amount on line 208 of your return RRSP deduction 208 PART D RRSP unused contributions available to carry forward Line 9 minus line 13 Your unused RRSP contributions available to carry forward to a future year We will show the amount of line 14 as amount (B) of "Your 2012 RRSP Deduction Limit Statement" on your 2011 notice of assessment. PART E 2011 withdrawals under the HBP and the LLP HBP : enter the amount from box 27 of all your 2011 T4RSP slips Tick this box if the address shown on page 1 of your return is the same as the address of the home you purchased under the HBP LLP : enter the amount from box 25 of all your 2011 T4RSP slips Tick this box to designate that your spouse or common-law partner was the student for whom the funds were withdrawn under the LLP Privacy Act, Personal Information Bank number CRA PPU 005 Page 1 of 1

10 T Donations and Gifts Schedule 9 For more information, see Line 349 in the guide and read Pamphlet P113, Gifts and Income Tax. 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. Donations made to registered charities, registered Canadian amateur athletic associations and Canadian low-cost housing corporations for the aged Donations made to government entities (Government of Canada, provinces or territories, municipal or public bodies performing a function of government in Canada). 2 Donations made to prescribed universities outside Canada. Donations made to the United Nations, its agencies and certain charitable organizations outside Canada Add lines 1 to 4. Total eligible amount of charitable donations and government gifts Enter your net income from line 236 of your return 60, x 75% = 45, Note: If the amount on line 5 is less than the amount on line 6, enter the amount from line 5 on line 340 below, and continue completing the schedule from line 340. Gifts of depreciable property (from Chart 2 in pamphlet P113, Gifts and Income Tax) Gifts of capital property (from Chart 1 in pamphlet P113, Gifts and Income Tax) Add lines 7 and 8. x 25% = 9 Enter the total of lines 6 and 9 or the amount on line 236 of your return, whichever is less. Total donations limit 45, Allowable charitable donations and government gifts (enter the amount from line 5 or line 10, whichever is less) Eligible amount of cultural and ecological gifts (see line 349 in the guide) Add lines 340 and Enter $200, or the amount from line 344, whichever is less x 15% = Line 344 minus line x 29% = Add lines 11 and 12. Enter this amount on line 349 of Schedule 1. Donations and gifts Privacy Act, Personal Information Bank number CRA PPU 005 Page 1 of 1

11 Donations Charitable donations details Name of organization Charitable donations Amount paid Reported on slips Claim: Own slips Total current year donations Donations to U.S. organizations Name of organization Amount paid Total current year donations <NIL> Other gifts Donations made to government entities Donations made to prescribed universities outside Canada. Donations made to the United Nations, its agencies, and certain charitable organizations outside Canada. Charitable donations summary Total current year donations Other gifts Unclaimed donations from Unclaimed donations from 2006 Total charitable donations Net income B 75% of line B C Gifts of depreciable property D Taxable capital gains minus capital gains deduction on gifts of capital property E Add lines D and E F 25% of line F G Add lines C and G Allowable U.S. donations Total donations limit Allowable charitable donations (least of lines A, J or amount required to reduce federal tax to zero) Charitable donations available for carryforward A H I J U.S. Canadian Total = = , = = 45, = = + + = = 45, = = 45, , Charitable donation carryforward - Canadian Year Beginning balance Claimed in 2011 Ending balance Totals Page 1 of 1

12 Ontario Ontario Tax ON428 T1 General Complete this form, and attach a copy to your return. For more information, see the related lines in the forms book. Step 1 Ontario non-refundable tax credits For internal use only 5605 Basic personal amount claim $9, , Age amount (if born in 1946 or earlier) (use the provincial worksheet) (maximum $4,445) Spouse or common-law partner amount Base amount 8, Minus: his or her net income from page 1 of your return Result: (if negative, enter "0") (maximum $7,730) Amount for an eligible dependant Base amount 8, Minus: his or her net income from line 236 of his or her return Result: (if negative, enter "0") 7, (maximum $7,730) , Amount for infirm dependants age 18 or older (use the provincial worksheet) CPP and QPP contributions: (amount from line 308 of your federal Schedule 1) , (amount from line 310 of your federal Schedule 1) Employment Insurance premiums: (amount from line 312 of your federal Schedule 1) (amount from line 317 of your federal Schedule 1) Adoption expenses Pension income amount Caregiver amount (use provincial worksheet) Disability amount (for self) (maximum $1,259) Disability amount transferred from a dependant (use provincial worksheet) Interest paid on your student loans (amount from line 319 of your federal Schedule 1) Your tuition and education amounts Tuition and education amounts transferred from a child [attach Schedule ON(S11)] , Amounts transferred from your spouse or common-law partner [attach Schedule ON(S2)] Medical expenses: (Read line 5868 in the forms book.) , Enter $2,061 or 3% of line 236 of your return, whichever is less. Line 19 minus line 20 (if negative, enter "0") 1, , Allowable amount of medical expenses for other dependants (use provincial worksheet) Add lines 21 and , , Add lines 1 through 18, and line , , Ontario non-refundable tax credit rate x 5.05 % 25 Multiply line 24 by line , Donations and gifts: Amount from line 345 of your federal Schedule x 5.05 % = Amount from line 347 of your federal Schedule 9 x % = 28 Add lines 27 and Add lines 26 and 29. Enter this amount on line 42. Ontario non-refundable tax credits , Go to Step 2. Page 1 of 3

13 Step 2 - Ontario tax on taxable income Enter your taxable income from line 260 of your return. If this amount is more than $20,000, you must complete Step 7 Ontario Health Premium 60, Complete the appropriate column depending on the amount on line 31. Line 31 is Line 31 is more than $37, but Line 31 is $37, or less not more than $75, more than $75, Enter the amount from line , , , Line 32 minus line 33 (cannot be negative) , x 5.05 % 35 x 9.15 % 35 x % 35 Multiply line 34 by line , , , Ontario tax on Add lines 36 and 37. taxable income 38 3, Step 3 Ontario tax Go to Step 3. Go to Step 3. Go to Step 3. Enter your Ontario tax on taxable income from line 38. 3, Enter your Ontario tax on split income from Form T Add lines 39 and 40. 3, Enter your Ontario non-refundable tax credits from line 30. 1, Ontario dividend tax credit: Credit calculated for line 6152 on the Provincial Worksheet Ontario overseas employment tax credit: Amount from line 426 of your federal Schedule 1 x % = Ontario minimum tax carryover: Amount from line 427 of your federal Schedule 1 x % = Add lines 42 through 45. Line 41 minus line 46 (if negative, enter "0") 1, , , Ontario additional tax for minimum tax purposes: Amount from line 95 of Form T691 x % = 48 Add lines 47 and 48. 2, Ontario surtax (Line 49 2, minus 4, ) x % (if negative, enter "0") 50 (Line 49 2, minus 5, ) x % (if negative, enter "0") 51 Add lines 50 and Add lines 49 and 52. 2, If you are not claiming an Ontario tax reduction and the credits in Steps 5 and 6, enter the amount from line 53 on line 68 and complete Step 7. Otherwise, continue below. Step 4 Ontario tax reduction Basic reduction If you had a spouse or common-law partner on December 31, 2011, only the individual with the higher net income can claim the amounts on lines 55 and 56. Reduction for dependent children born in 1993 or later Number of dependent children x = Reduction for dependants with a mental or physical infirmity Number of dependants 6097 x = 56 Add lines 54, 55, and Enter the amount from line 57. Enter the amount from line x 2 = 1, , Line 58 minus line 59 (if negative, enter "0") Ontario tax reduction claimed 60 Line 53 minus line 60 (if negative, enter "0") 2, Go to step 5. Page 2 of 3

14 Enter the amount from line 61 on the previous page. 2, Step 5 Ontario foreign tax credit Enter the Ontario foreign tax credit from Form T Line 62 minus line 63 2, Step 6 Labour sponsored investment fund (LSIF) tax credit Total cost of shares from boxes 02 and 04 of LSIF tax credit certificate(s) A x 5 % (max. $375) Total cost of ROIF eligible shares from boxes 03 and 05 of LSIF tax credit certificate(s) B x 5 % (max. $375) Add lines 65 and 66. LSIF tax credit 67 Line 64 minus line 67 (if negative, enter "0") 2, Step 7 Ontario Health Premium If your taxable income (from line 31) is not more than $20,000, enter "0". Ontario Otherwise, enter the amount calculated in the chart below. Health Premium Add lines 68 and 69. Enter the result on line 428 of your return. Ontario tax 3, Ontario Health Premium Enter your taxable income from line , Go to the line that corresponds to your taxable income. If there is an Ontario Health Premium amount on that line, enter that amount on line 69 above. Otherwise, enter your taxable income in the first box, complete the calculation, and enter the result on line 69 above. Taxable Income Ontario Health Premium not more than $20,000 $0 more than $20,000, but not more than $25,000 - $20,000 = x 6% = more than $25,000, but not more than $36,000 $300 more than $36,000, but not more than $38,500 - $36,000 = x 6% = + $300 = more than $38,500, but not more than $48,000 $450 more than $48,000, but not more than $48,600 - $48,000 = x 25% = + $450 = more than $48,600, but not more than $72,000 $600 more than $72,000, but not more than $72,600 - $72,000 = x 25% = + $600 = more than $72,600, but not more than $200,000 $750 more than $200,000, but not more than $200,600 - $200,000 = x 25% = + $750 = Go to step 6. Go to step 7. more than $200,600 $ Privacy Act, Personal Information Bank number CRA PPU 005 Page 3 of 3

15 Ontario Ontario Credits Complete this form, and attach a copy to your return to claim your Ontario credits. For more information about these credits, read the related lines in the forms book. ON479 T1 General Ontario children's activity tax credit Enter your total claim for the children's activity tax credit X 10% = Ontario political contribution tax credit Ontario political contributions made in Credit calculated for line 3 on the Provincial Worksheet (maximum $1,240) 3 Ontario focused flow-through share tax credit Enter the total expenses reported on Form T x 5% = 4 Add lines 1, 3, and 4. If you are not claiming Ontario tax credits for self-employed individuals, enter the amount from line 5 on line 479 of your return Ontario tax credits for self-employed individuals 5 Number of eligible apprentices your business or partnership hired under the Ontario apprenticeship training tax credit program Number of eligible work placements your business or partnership is claiming under the Ontario co-operative education tax credit program Are you claiming one or more of these tax credits as a member of a partnership? Yes 2 No If yes, enter the first nine digits of your business number Ontario apprenticeship training tax credit See page 8 in the forms book. Ontario co-operative education tax credit See page 8 in the forms book Add lines 5, 6, and 7. Enter the result on line 479 of your return. Ontario credits Page 1 of 1

16 Canada Revenue Agence du revenu Agency du Canada Child Care Expenses Deduction for 2011 Read the attached information sheet. On the sheet we define child care expenses, eligible child, net income, earned income, and educational program. For more information, see Interpretation Bulletin IT-495, Child Care Expenses. Each person claiming the child care expenses deduction must attach a completed Form T778 to his or her return. Do not include receipts, but keep them in case we ask to see them. If you are the only person claiming child care expenses, complete parts A and B, and, if it applies, Part D. If there is another person (as described under "Who can claim child care expenses?") and you are the one with the lower net income, complete parts A and B. If there is another person (as described under "Who can claim child care expenses?") and you are the one with the higher net income, complete parts A, B, C, and, if it applies, Part D. Child care expense details Name of child Organization or name and social insurance number # weeks** Amount Claim Johnny Busy Kids Day Care 1, , Sarah Busy Kids Day Care 3, Sarah Mrs.Friend Lee Neighbour , Johnny Local Summer Overnight Hockey Camp **Enter the # of weeks spent at boarding school, overnight sports school or overnight camp. Part A - Total child care expenses List the first and last names and the dates of birth of all your eligible children, even if you did not pay child care expenses for all of them. Indicate who received the payments. Provide the name of the child care organization or the name and social insurance number of the individual. Child's Last and First Name Date of Birth Name and SIN of individual, or name of organization Number of weeks Child care expenses paid Busy, Johnny 2003/10/01 See details above 2 1, Busy, New 1999/06/01 Total child care expenses 1, Note: The maximum you can claim for expenses that relate to a stay in a boarding school (other than education costs) or an overnight camp (including an overnight sports school) is $175 per week for a child included on line 1 in Part B, $250 per week for a child included on line 2, and $100 per week for a child included on line 3. Enter any child care expenses included above that were incurred in 2011 for a child who was 18 or older. Part B - Basic limit for child care expenses Number of eligible children: Born in 2005 or later, for whom the disability amount cannot be claimed X $7,000 = 1 Born in 2011 and earlier, for whom the disability amount can be claimed * X $ = Born in 1995 to 2004, (or born in 1994 or earlier, with a mental or physical impairment,for whom the disability amount cannot be claimed) Add lines 1, 2, and 3. Enter your total child care expenses from Part A. 2 X $4,000 = 8, , , Enter your earned income. 62, X 2/3 = 41, Enter the amount from line 4, 5, or 6, whichever is least 1, If you are the person with the higher net income, go to Part C. Leave lines 8 and 9 blank. Enter any child care expenses that the other person (as described under "Who can claim child care expenses?") with the higher net income deducted on line 214 of his or her 2011 return. Line 7 minus line 8. If you attended school in 2011 and you are the only person making a claim, also go to Part D. Otherwise, enter this amount on line 214 of your return. Your allowable deduction 1, * Attach Form T2201, Disability Tax Credit Certificate. If this form has already been filed for the child, attach a note to your return showing the name and social insurance number of the person who filed the form and the tax year for which it was filed T778 E (11) Page 1 of 2

17 Part C - Are you the person with the higher net income? Complete Part C if, in 2011, another person (as described under "Who can claim child care expenses?") with lower net income was in a situation described below. Give the name, social insurance number, and the net income of the other person, and tick the boxes that apply. Name of person with lower net income Social insurance number Net income a) The other person attended school and was enrolled in a part-time educational program (see "Educational program" on the T778 information sheet). b) The other person attended school and was enrolled in a full-time educational program (see "Educational program" on the T778 information sheet). c) The other person was not capable of caring for children because of a mental or physical infirmity. That person must have been confined for a period of at least two weeks to a bed or wheelchair, or as a patient in a hospital, or other similar institution. Attach a statement from the attending physician certifying this information. d) The other person was not capable of caring for children because of a mental or physical infirmity, and this situation is likely to continue for an indefinite period. Attach a statement from the attending physician certifying this information. e) The other person was confined to a prison or similar institution for a period of at least two weeks. f) You and your spouse or common-law partner were, due to a breakdown in your relationship, living separate and apart at the end of 2011 and for a period of at least 90 days beginning in 2011, but you reconciled before March 1, Line 4 (in Part B) x 2.5 % = 10 Number of months in 2011 that the situation in a) existed (other than a month that includes a week that any of the situations in b) to f) existed) x line 10 = 11 Number of weeks in 2011 that any of the situations in b) to f) existed x line 10 = 12 Add lines 11 and Enter the amount from line 7 (in Part B) or line 13, whichever is less. If you attended school in 2011, go to Part D. Otherwise, enter this amount on line 214 of your return Your allowable deduction 14 Part D - Are you enrolled in an educational program in 2011? Complete Part D if, at any time in 2011, either of the following situations applied to you: You were the only person making a claim, line 7 equals line 6 in Part B, and you were enrolled in a program (see "Educational program"). You were the person with the higher net income, line 7 equals line 6 in Part B, and, at the same time in 2011, you and another person (as described under "Who can claim child care expenses?") were enrolled in a program (see "Educational program"). But first, complete Part C. Part D does not apply to the person with the lower net income, since the other person will claim this part of the deduction for both of them. Line 4 (in Part B) 8, x 2.5 % = Number of weeks in 2011 during which you were enrolled in a full-time educational program. If there was another person (as described under "Who can claim child care expenses?"), he or she must also have been enrolled in a full-time educational program during the same weeks. x line = 16 Number of months (other than any month that includes a week used to calculate the amount on line 16) in 2011 during which: there was no other person (as described under "Who can claim child care expenses?") and you were enrolled in a part-time educational program; or you and the other person were enrolled in a full-time or part-time educational program during the same months. x line = 17 Add lines 16 and Line 4 (in Part B) minus line 9 (in Part B) or line 14 (in Part C), whichever applies to you 6, Line 5 (in Part B) minus line 9 (in Part B) or line 14 (in Part C), whichever applies to you 20 Enter your net income (not including amounts on line 214 or 235) 61, X 2/3 = 40, If you completed Part C: Line 13 (in Part C) minus line 6 (in Part B) 22 Enter the amount from line 18, 19, 20, 21, or (if it applies) 22, whichever is least. 23 Enter the amount from line 9 (in Part B) or line 14 (in Part C), whichever applies to you. 24 Add line 23 and line 24. Enter this amount on line 214 of your return. Your allowable deduction 25 Privacy Act, Personal Information Bank number CRA PPU 005 Page 2 of 2

18 Canada Revenue Agence du revenu EMPLOYEE OVERPAYMENT OF 2011 CANADA PENSION PLAN Agency du Canada CONTRIBUTIONS AND 2011 EMPLOYMENT INSURANCE PREMIUMS Complete Section A in Part 1 to determine any overpayment of Canada Pension Plan (CPP) or Quebec Pension Plan (QPP) contributions made through employment if you had no self-employment earnings and you were not a resident of Quebec on December 31, However, if you worked in Quebec, or you worked in Quebec and in a province other than Quebec in 2011, and you were either 70 years of age or older, or you received a CPP or QPP retirement pension, complete Section B in Part 1. Do not complete Section A in Part 1. Note: If the individual died in 2011, complete Section A in Part 1. Do not complete this form if you were a resident of Quebec on December 31, 2011, and you made CPP or QPP contributions. See line 452 in your Quebec provincial income tax guide. Complete Part 2 on the next page to determine any overpayment of Employment Insurance (EI) premiums paid through employment. Part 1 - Calculating your Canada Pension Plan overpayment Section A - Read the above instructions to determine if you should complete this section. If any of the following situations apply to you, read the instructions below and if applicable, use the table to determine the maximum amounts for lines 1, 2, 3, and 5: If throughout 2011, you were over 70 years of age or you received CPP or QPP retirement pension, enter "0" at line 1. If you turned 18 years of age in 2011, use the number of months in the year after the month you turned 18 years of age. If you turned 70 years of age in 2011, use the number of months in the year up to and including the month you turned 70 years of age. If you received, or were entitled to receive a CPP or QPP retirement pension, or a CPP or QPP disability pension for part of 2011, use the number of months in the year you did not or were not entitled to receive the pension. If the individual died in 2011, use the number of months in the year up to and including the month the individual died. Total CPP/QPP pensionable earnings (box 26 or, if blank, box 14 of your T4 slips) (maximum $48,300) 48, Basic CPP/QPP exemption (maximum $3,500) - 3, Earnings subject to contribution (if negative, enter "0") (maximum $44,800) = 44, Total CPP/QPP contributions deducted (from boxes 16 and 17 of your T4 slips) 2, Required contribution: multiply line 3 by 4.95%. (maximum $2,217.60) - 2, Line 4 minus line 5 (if negative, enter "0") Canada Pension Plan overpayment = 6 If the amount from line 6 is positive, enter it on line 448 of your return. If negative, you can choose to make additional CPP contributions. See "Making additional CPP contributions" on page 35 of the General Income Tax and Benefit Guide. Enter the amount from line 4 or 5, whichever is less, on line 308 of Schedule 1 and, if it applies, on line 5824 of Form 428. Section B - Complete this section only if you worked in Quebec, or you worked in Quebec and in a province other than Quebec in 2011, and you were either 70 years of age or older, or you received a CPP or QPP retirement pension. If any of the following situations apply to you, determine the amount to enter at line 7 as follows: If throughout 2011, you were over 70 years of age or you received CPP or QPP retirement pension, enter "0" at line 7. If you turned 70 years of age in 2011, use the above table to determine the maximum amount for line 7 by using the number of months in the year up to and including the month you turned 70 years of age. If you received, or were entitled to receive a CPP or QPP retirement pension, or a CPP or QPP disability pension for part of 2011, use the monthly proration table to determine the maximum amount for line 7 by using the number of months in the year you did not or were not entitled to receive the pension. Total CPP pensionable earnings (box 26 or, if blank, box 14 of your T4 slips where the province of employment is not Québec) or the maximum amount as per above instructions, whichever is less. CPP pensionable earnings 7 Total QPP pensionable earnings (box 26 or, if blank, box 14 of your T4 slips where the province of employment is Québec) Add lines 7 and 8. Total CPP/QPP pensionable earnings Basic CPP/QPP exemption Earnings subject to contribution (if negative, enter "0") QPP pensionable earnings (maximum $ 48,300) (maximum $ 44,800) + = - = Total CPP and QPP contributions deducted (from boxes 16 and 17 of your T4 slips) 12 Required contribution: multiply line 11 by 4.95% (maximum $2,217.60) - 13 Line 12 minus line 13 (if negative, enter "0") Canada Pension Plan overpayment = 14 If the amount from line 14 is positive, enter it on line 448 of your return. Enter the amount from line 12 or 13, whichever is less, on line 308 of Schedule 1 and, if it applies, on line 5824 of Form 428. T2204 E (11) Page 1 of 2

19 Complete Part 2 to determine any overpayment of Employment Insurance (EI) premiums. To be refunded, the amount of the EI overpayment has to be more than $1. Do not complete Part 2 if you were a resident of Quebec on December 31, 2011, and you have to complete Schedule 10. Part 2 - Calculating your Employment Insurance overpayment Total EI insurable earnings (box 24 or, if blank, box 14 of your T4 slips) (maximum $44,200. If $2,000 or less, enter "0") 44, Total premiums deducted: Residents of other than Quebec (from box 18 and box 55 of all your T4 slips) Quebec residents (from box 18 of all your T4 slips) Line 1 minus $2,000 (if negative, enter "0") - 42, Line 2 minus line 3 (if negative, enter "0") = 4 Total premiums deducted: Residents of other than Quebec (from box 18 and box 55 of all your T4 slips) Quebec residents (from box 18 of all your T4 slips) Required premium: Residents of other than Quebec (multiply line 1 by 1.78%) (maximum $786.76) Quebec residents (multiply line 1 by 1.41%) (maximum $623.22) Line 5 minus line 6 (if negative, enter "0") = Enter the amount from line 4 or line 7, whichever is greater Employment Insurance overpayment Enter the amount from line 8 on line 450 of your return only if it is more than $1. Enter the amount from line 3, 5 or 6, whichever is least, on line 312 of Schedule 1 and, if it applies, on line 5832 of Form 428. Privacy Act, Personal Information Bank number CRA PPU 005 T2204 E (11) Page 2 of 2

20 2011 Slip Summary NAME: Busy Single-Mom, Ima SIN: T4 Slips - Feuillets T4 Description 1 Local School Board Total Province of employment Employment income CPP contributions EI premiums RPP contributions Pension adjustment Income tax deducted EI insurable earnings CPP/QPP pensionable earnings Union dues Charitable donations Ontario 62, , , , , , , , , , , , , , RRSP Contributions - Cotisation Description Contribution period Contribution to own RRSP 1 Your Favourite Advisor March 2 to December 31, Your Favourite Advisor January to February 29, Total RC62 - PUGE Total benefit paid 1 1, Total

21 CTB Are you eligible to receive the Child Tax Benefit? Yes X No Child Tax Benefit Qualified dependants Name Birthdate Basic benefit July 2012 to June 2013 National Child Benefit supplement Johnny Busy 2003/10/01 1, , New Busy 1999/06/01 1, , Subtotal 2, , Totals 2, , Calculation of benefits for July 2012 to June 2013 Child Disability Benefit Supplement Basic benefit 2, Benefit reduction: Taxpayer's 2011 adjusted net income Spouse's 2011 adjusted net income Less: Universal Child Care Benefit (UCCB) Universal Child Care Benefit repayment Less: Registered Disability Savings Plan (RDSP) income Registered Disability Savings Plan repayment 2011 family adjusted net income Reduction of 2% of line A for 1 child; 4% for 2 or more Subtotal Less Subtotal 60, , , , , Subtotal A , , National Child Benefit supplement 4, Benefit reduction: 2011 family adjusted net income 12.2% of line B for 1 child; 23% for 2; 33.3% for 3 or more Less Subtotal 60, , , Subtotal B - 8, Child Disability Benefit supplement Benefit reduction: 2011 family adjusted net income 2% of line C for 1 child; 4% for 2 or more Less Subtotal 60, , , Subtotal C - + ESTIMATED Child Tax Benefit for July 2012 to June if less than $120, amount is payable as a lump sum in July 2012 ESTIMATED Monthly Child Tax Benefit 2, Page 1 of 2

22 CTB Child Tax Benefit This worksheet is for information purposes only. The calculation of these benefits is an estimate based on the federal and provincial legislation available to us. Canada Revenue Agency will calculate the actual benefits, which may differ from this estimate. Page 2 of 2