SIN # SIN # Divorced. Yes Yes

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1 Millcreek Drive, Mississauga, Ontario L5N 5R3 Telephone Facsimile Tax Return Checklist Your name Your spouse Address SIN # Birthdate / / SIN # Birthdate / / Work telephone number Spouse work number DD MM YY Did you move in the year Home telephonee number ( ) - ( ) - ( ) - Marital Status Married Widowed Divorced Did your marital status change? Are we preparing a tax return for your spouse? If we are NOT preparing a tax return for your spouse, pleasee provide the following: Net income figure from line 236 on page 2 of his/her 2013 tax return Common-law Separated Single Iff so, provide date $ List any dependents who were 18 years of age or under as of December 31, 2013 Name Relationship 2013 net income Birthdatee SIN # $ / / $ / / $ / / DD MM YY Do you, your spouse or any of your dependants qualify for the disability credit? (if so, indicate whom) DELIVERY OF RETURN AND OTHER IMPORTANTT MATTERS (un nless otherwise indicated we will assume the default response) Default Do you own/hold foreign assets with a cost of more than $100,000 at any time during 2013 (if so, please complete the attached pages 6 and 7)? Do you authorize CRA to provide information about you to Elections Canada? Are you a volunteer firefighter? Do you want your tax refund deposited directly to your bank account? (attach details) NO YES NO (attach a void cheque) Direct depositt requested last year NO How do you want your tax return delivered once, it has been completed by our staff? MAIL Hold for pick-upp Mail to my home address via Canada Post Other (please specify) Courier to my home address (There is a minimum handling charge of $10.00 for this service) PLEASEE PROVIDE A COPY OF YOUR 2012 NOTICE OF ASSESSMENT WITH THIS CHECKLIST Are either you or your spouse a US citizen? Weree either you or spouse born in the US? Are either you or your spouse green-card spouse spentt more than 120 days in the US in 2013, in 2012, in 2011 (business or pleasure; count partial days as 1 full day)? holders (either now or anytime in the past 10 years)? Have either you or your Did either you or your spouse receivee any wages or consulting income from US payerss in 2013? Do you and/or your spouse own a US vacation home or US rental property (either heldd jointly, or as tenants-in-common)?

2 SOURCES OF INCOME (Check if you have any of the following sources of income.) Source Slip to bring Employment income T4 Taxable disability income T4A Profit sharing income T4PS Commission income T4 or T4A Old Age Security T4(OAS) Canada Pension Plan T4AP Other pension/annuities T4A RRSP income T4RSP RRIF income T4RIF Withdrawals from RRSP T4RSP EI benefits T4E Workers Safety Insurance T5007 Social assistance payments T5007 Scholarships and bursaries T4A Dividends T3 or T5 Interest T5 Limited partnership T5013 Universal Child Care Benefit RC62 Rental income Summarize on page 4 Sale of real estate Summarize on page 4 Sale of securities Summarize on page 4 Self-employed income Summarize on page 3 Alimony Child support (taxable) DEDUCTIONS AND TAX CREDITS AVAILABLE (Check if you have any of the following deductions and INCLUDE ORIGINAL RECEIPTS in all cases.) Source Investment loan interest Safety deposit box charges Investment counseling fees RRSP contributions First Time Homebuyer s credit Homebuyers Plan withdrawals/ pmts Lifelong Learning Plan withdrawals/ pmts Moving expenses Union dues and professional fees Child care expenses First time charitable donations donor in 2013 Yes Charitable donations Political party contributions - FEDERAL Political party contributions - ONTARIO Tuition fees - SELF Tuition fees SPOUSE / CHILDREN Rent paid Property taxes paid Interest paid on student loans Tax instalments paid to government Transit passes Children s Fitness Children s Art Healthy Home Renovation expenses (Please complete the attached schedule) Tips and gratuities (Check if you have any of the following deductions and ensure that you have the receipts to support the following items. If unsure, attach receipts.) Employment expenses Summarize on page 3 Alimony payments made Child support (ONLY if deductible) Medical expenses Do you elect to receive your 2014 Ontario Trillium Benefit (OTB) in one payment in June 2015 If you have other income and/or deductions that are not listed above, please itemize below and attach supporting receipts.

3 EMPLOYMENT EXPENSES Please include a signed T2200 Declaration of Employment Conditions from your employer. HOME OFFICE (for business and employment) Percentage of home used for business Expense Source Accounting Heat Advertising and promotion Hydro Food, beverages and entertainment Water Lodging Insurance (*see below) Parking Maintenance and repairs Supplies (ex. postage, stationery, other) Mortgage interest (self-employed only) Telephone Property taxes (*see below) Rent * apply for self-employed and commission employees only Automotive expenses Office in home expenses AUTOMOBILE EXPENSES (for business and employment) Summarize below Summarize below Year and make of automobile SELF-EMPLOYED INCOME AND EXPENSES Name of business Type of business Name of partner and % owned SIN # of partner Income Expenses Year of purchase Advertising Purchase price Licenses, dues, memberships and subscriptions kilometres driven in year Insurance kilometres driven in year (for business) Interest and bank charges Expense Meals and entertainment Fuel Office supplies Repairs and maintenance Legal and accounting Insurance Rent Licensing or registration Salaries Loan interest Telephone Lease payments 407 ETR Equipment and furniture purchases Car washes HST Business number Do above s include HST?

4 RENTAL PROPERTY (if property was purchased, please provide the Agreement of Purchase and Sale and the solicitor s reporting letter) Address Name of partner and % owned SIN # of partner Income SALE OF REAL ESTATE (please provide the Agreement of Purchase and Sale and the solicitor s reporting letter for BOTH your sale and purchase) Address Name of partner and % owned SIN # of partner Date sold Date purchased Expenses Insurance Mortgage interest Repairs and maintenance Property taxes Utilities Advertising Management and administration Professional fees Purchase price Legal and other costs on purchase Additions and/or major improvements Sale price Legal and other costs on purchase Commissions paid on sale Major renovations and purchases (i.e. appliances) SALE OF SECURITIES (in non-rrsp or other registered plan) (please provide broker s statements for both purchase and sale) Name of stock US$ Date sold Number of shares Sale price Purchase price Commissions (Y/N) (Please ensure that the sale price and the purchase price is total for the number of shares sold) The above summary should also include transfers or sales of mutual funds. Transfers also include systematic withdrawal programs. Please provide the December 31 st year-end statements for ALL non-rrsp or other registered mutual funds. These statements should have been sent to you by the mutual fund companies in January. The statements should show all the transactions for the year, including any sale, redemption or transfer of mutual funds.

5 HEALTHY HOMES RENOVATION TAX CREDIT If you qualify for the Healthy Homes Renovation Tax Credit (i.e: you are 65 year old or older by the end of 2013 or you are living with a family member who is a senior and you incurred costs to make your home safer and more accessible), please list below your eligible healthy home renovation expenses relating to work billed between January 1, 2013 and December 31, Please note that not all renovation work qualifies for this tax credit and as such before completing this form please visit the Ontario site at: Date on sales slip or contract Supplier or Subcontractor Supplier or Subcontractor Description of goods or work performed paid Name HST Number (including taxes) Please ensure to keep your receipts in case the Canada Revenue Agency asks to see them.

6 <NoName> SIN: Printed: 2014/02/19 12:34 Canada Revenue Agence du revenu Protected B when completed Agency du Canada Foreign Income Verification Statement This form must be used for the 2013 and later taxation years. Complete and file this form if at any time in the year the total cost to the reporting taxpayer of all Specified Foreign Property was more than $100,000 (Canadian). Enter CAD (Canadian) or, where an election has been made to use a functional currency, other than the Canadian dollar, enter the functional currency code NA See attached instructions for more information about completing this form. If this is an amended return check this box. Identification Check a box to indicate who you are reporting for, and complete the areas that apply. First name Last name Initial X Individual Corporation Trust Corporation's name Trust's name Partnership's name Partnership Reporting taxpayer's address For departmental use SIN Individual code 1 2 Business Number (BN) RC Account number T - - Partnership code Identification number No. Street Postal code City Province or territory For what tax year are you filing this form? 2013 or From To Categories of Specified Foreign Property Where the reporting taxpayer has received a T3 or T5 from a Canadian issuer in respect of a specified foreign property for a taxation year, that specified foreign property is excluded from the T1135 reporting requirement for that taxation year. If any of the Specified Foreign Property held is subject to the above exclusion, check this box: In each of the following tables, provide the required details of each Specified Foreign property held at any time. If you need additional space please attach a separate sheet of paper using the same format as the tables. 1. Funds held outside Canada Name of bank/other entity holding the funds Funds held 2. Shares of non-resident corporations (other than foreign affiliates) Name of corporation Cost Privacy Act, Personal Information Bank number CRA PPU 205 T1135 E (13) (Ce formulaire existe en français.) Page 1 of 2

7 <NoName> SIN: Printed: 2014/02/19 12:45 3. Indebtedness owed by non-resident Description of indebtedness Cost 4. Interests in non-resident trusts Name of trust Cost Income received Capital received 5. Real property outside Canada (other than personal use and real estate used in an active business) Cost Description of property 6. Other property outside Canada Description of property Cost Certification I certify that the information given on this statement is, to my knowledge, correct and complete, and fully discloses the reporting taxpayer's specified foreign property and related foreign income. Name Sign here Position/title Phone It is a serious offense to file a false statement. ( ) - Date If someone other than the taxpayer or the partnership prepared this form, provide their: Name Address Telephone ( ) - Privacy Act, Personal Information Bank number CRA PPU 205 T1135 E (13) (Ce formulaire existe en français.) Page 2 of 2