Name : Address : CHECKLIST - INCOME TAX 2018 This questionnaire is intended to assist you in gathering your tax information and organizing your tax file, prior to the production of your income tax returns. You are under no obligation to fill out this questionnaire. However, we call your attention to section 1 which contains information required for the preparation of your returns. Sections 2 to 4, as well as appendices 1 and 2, will guide you in the gathering of tax information to be forwarded to us. We remind you that you alone are responsible for providing us with complete and accurate tax information. We commit to producing income tax returns using the information, tax slips and receipts that you will have provided to us. We will not audit, review or otherwise attempt to verify the accuracy or completeness of any information provided. GROUPE CONSEIL WERMENLINGER Mario Sylvestre, CPA, CGA, F. Pl. 1170 Peel Street, Suite 300 Montreal (Quebec) H3B 0A9 Tel : 514-985-7562 Toll-free number : 1-877-780-1171 poste 5062671 Fax : 514-281-4255 E-mail : mario.sylvestre@desjardins.com
SECTION 1 - CHECKLIST PERSONAL INCOME TAX 2018 SELF SPOUSE Name First name Initials Last name Name First name Initials Last name S.I.N. - - S.I.N. - - DATE OF BIRTH TELEPHONE E-MAIL DATE OF DEATH / / / / MARITAL STATUS AS AT DECEMBER 31, 2018 DATE OF BIRTH TELEPHONE E-MAIL DATE OF DEATH / / / / If changed during 2018, please give exact date : / / Living alone or living with one or more dependents Home Buyer's Amount? OUI NON Single Separated Common-Law spouse Married Divorced Common-Law spouse (same sex) Widowed Do we prepare your spouse's income tax returns? YES NO If not, please provide Federal - Net income : (line 236) Quebec (line 275) 8CHILDREN AND RELATIVES WHO WERE DEPENDENTS IN 2018 If we produced their returns last year, please indicate any changes that occured in 2018. NAME DATE OF BIRTH (Day/month/year) / / / / / / S.I.N. - - - - - - TUITION FEES (T2202/R8) DISABLED (YES/NO) PREPARING THEIR RETURNS IF not, Net income Federal : Quebec : Were you covered by a drug insurance plan offered by your employer, professional association or insurance company during 2018? If yes, number of months covered : In 2018, were you part of a complementary drug insurance plan, RAMQ being the first payor? RESIDENCE YES NO Line 236 Line 275 QUEBEC PRESCRIPTION DRUG INSURANCE PLAN (RAMQ) Province of Residence as of December 31, 2018? If other province, please specify which one? Are you a citizen of another country? If yes, specify? TIES WITH UNITED STATES OF AMERICA * Number of days spent in the U.S.A. in: 2016 (Specify number of days) 2017 2018 * If more than 31 consecutive days spent in U.S.A. in 2018. YES NO Line 236 Line 275 YES NO YES NO Quebec Ontario YES NO Line 236 Line 275 SELF SPOUSE DEPENDENTS SELF SPOUSE DEPENDENTS Income Tax 2018 Page 2 of 6
SECTION 2 - CHECKLIST INCOME TAX 2018 INCOME SENT SLIPS/RECEIPTS NOT LATER THAN: FEDERAL QUEBEC SELF SPOUSE DEPENDANTS Salary February 28, 2019 T4 Rel 1 Employee Profit Sharing Plan February 28, 2019 T4PS Rel 25 Stock options exercised February 28, 2019 T4 Rel 1 Other employment income February 28, 2019 T4A Rel 1 Pension adjustment reversal (PAR) T10 Employment Insurance benefits February 28, 2019 T4E Rel 6 Old age security pension (no. months ) February 28, 2019 T4A(OAS) Canada / Quebec pension (no. months ) February 28, 2019 T4A (P) Rel 2 Other Pension Income February 28, 2019 T4A Rel 2 RRSP Withdrawals February 28, 2019 T4RSP Rel 2 RRIF Withdrawals February 28, 2019 T4RIF Rel 2 Universal child care Benefit (if applicable) February 28, 2019 RC62 Dividends/Interest (50 or more) February 28, 2019 T5 Rel 3 Dividends/Interest (less than 50) Refund interest on prior year's tax returns Interest on CSB's/QSB's February 28, 2019 T5 Rel 3 Encashment of CSB's/QSB's (if applicable) T600 Rel 13 Trust income April 1, 2019 T3 Rel 16 Mutual funds income distribution April 1, 2019 T3 Rel 16 Net partnership income April 1, 2019 T5013 Rel 15 Subsidies (Quebec Gov.) February 28, 2019 Rel 27 Retirement allowance February 28, 2019 T4A/T3 Rel 1, 16 Scholarships, Bursaries, Grants, Death Benefits February 28, 2019 T4A/T3 Rel 1, 16 Advance payments of tax credits* (page 4) February 28, 2019 s/o Rel 19 Other income not listed Provide details Capital gains February 28, 2019 T5008 Rel 18 Disposition of your residence (if applicable, mandatory) See Appendix 1 Rental income (statement of income and expenses) See Appendix 2 Self-employment income (including farming income) Alimony received : Amount received Taxable amount Foreign income Interest, dividends from U.S.A.(paid to a non-resident of USA) March 15, 2019 Interest, dividends from U.S.A.(Paid to a US citizen or Green card holder) January 31, 2019 Capital gains from U.S. citizen January 31, 2019 Provide details Notice of Assessment FORM 1042S FORM 1099 INT, DIV 1099 B Please provide details Please provide details DEDUCTIONS FEDERAL SLIPS/RECEIPTS QUEBEC SELF SPOUSE DEPENDANTS RRSP (contributions made between March 1 and Dec 31, 2018) RRSP (contibutions made between Jan. 1, and Feb. 1, 2019) RRSP (contibutions made between Feb. 2, and March 1, 2019) Union or Professional dues Attendant care expenses Unreimbursed moving expenses Investment loan interest Investment carrying charges (Counselling, QSSP fee etc.) Generally, receipts sent beginning of January Generally, receipts sent mid-february Generally, receipts sent 10 working days after cont. Tax shelters (Partnership, R&D, Film, Oil & Gas) T101/T5013 Rel 11, 15 Quebec Tax Shelters ( CIP) Rel 7 Other employment expenses (home office, car) T2200 TP-64.3 Child care expenses Rel 24 / Rel 30 Name - S.I.N. - Amount paid Alimony paid - Name of beneficiary - S.I.N. - Amount paid Income Tax 2018 Page 3 of 6
SECTION 3 - CHECKLIST INCOME TAX 2018 CREDITS* FEDERAL SLIPS/RECEIPTS QUEBEC SELF SPOUSE DEPENDENTS Tuition fees and education amount T2202A Rel 8 Disability (Certified on prescribed form by a qualified practitioner) T2201 TP752.0.14 Labour-Sponsored venture capital funds investment T5006 Rel 10 Recognition of Volunteer Respite Services Rel 23 Capital regional et Coopératif Desjardins Shares Rel 26 Unreimbursed eligible medical expenses Charitable donations (receipt must show registration number) and donation of foods products Political contributions Loan interest for student loan Children's fitness and arts amount n/a Senior's activities Alternative Minimum Tax Carryforward Premium paid for private health service plan Treatment of infertility TP1029.8.66.2 Adoption fees TP1029.8.63 Home-Support Services for Senior TP1029.MD.5 Independent living tax credit for seniors Advance payments of tax credits Rel 19 (respecting work premium, child-care expenses or home-support services for senior) Purchase of a first home and Home Buyer's Plan (HBP) Details Details Please provide details RénoVert Tax Credit (end date March 2019) n/a TP-1029.RV Please provide details Eligible educator school supply n/a Please provide details Home accessibility expenses (older than 65 and or disabled) n/a Please provide details Grant for seniors to offset a municipal tax increase Solidarity tax credit Municipal tax bill Municipal tax bill/ Rel 31 Caregiver of an eligible relative? Yes No SECTION 4 - CHECKLIST INCOME TAX 2018 TAX PAID IN 2018 SELF SPOUSE DEPENDENTS TOTAL CANADA INCOME TAX INSTALMENTS PAID FEDERAL PROVINCIAL TOTAL U.S.A. INCOME TAX INSTALMENTS PAID United States (Federal) States of U.S.A. Provide 2017 Notice of Assessment Other correspondence received from tax authorities Thank you for organizing your tax information for us. The completeness and accuracy of your tax returns depend on the information you provide to us. PLEASE RETURN THIS QUESTIONNAIRE AND ALL DOCUMENTS TO US WHEN COMPLETE PLEASE DO NOT SEPARATE YOUR TAX SLIPS FILL OUT APPENDIX 1 AND/OR 2, IF APPLICABLE THANK YOU Income Tax 2018 Page 4 of 6
APPENDIX 1 STATEMENT OF DISPOSITIONS DURING 2018¹ Name : Name of broker : Phone number : Date of Acquisition Date of disposition Number of shares or units Description Sale price A Purchase price B Commissions C Capital Gain (Loss) A-B-C ¹Including the sale of principal residence Income Tax 2018 Appendix 1 Page 5 of 6
APPENDIX 2 RENTAL INCOME DURING 2018 Details of rental property PROPERTY 1 PROPERTY 2 Address Number of rental units Rent beginning period Rent ending period Expenses related to personal use % % STATEMENT OF INCOME AND EXPENSES INCOME Rental income Other related income EXPENSES Advertising Insurance cost Interest Total income A Accounting, administration fees Maintenance and repairs* Property taxes Utilities (light and power) Other : Total expenses Less: Expenses related to personal use Eligible expenses B Your ownership share (%) Net income A-B % % Your net income * If you claim contractual employment expenses, please fill out Form TP1086.R.23.12 (Quebec resident only) or attach details of these expenses (name of contractual, S.I.N. or QST number, amount paid for services). Purchase cost (if purchased in 2018) Additions in 2018 (capital expenses) UCC as of December 31, 2017 Specify Income Tax 2018 Appendix 2 Page 6 of 6