Free untitled - Canada

T1-2009

Statement of Investment Income

Schedule 4

State the names of the payers below and attach any information slips you received. Attach a separate sheet of paper if you need more space. Attach a copy of this schedule to your return. I ­ Taxable amount of dividends (eligible and other than eligible) from taxable Canadian corporations (see line 120 in the guide) Taxable amount of dividends other than eligible dividends (specify): e e Add lines 1 to 3 and enter this amount on line 180 of your return. 180 e Taxable amount of eligible dividends (specify): e e Add lines 4 to 7 and enter this amount on line 120 of your return. 120 II ­ Interest and other investment income (see line 121 in the guide) Specify: Income from foreign sources: Enter this amount on line 121 of your return. 121 IlI ­ Net partnership income (loss) (see line 122 in the guide) e Enter this amount on line 122 of your return. 122 IV ­ Carrying charges and interest expenses (see line 221 in the guide) Carrying charges (specify): e Interest expenses (specify): Enter this amount on line 221 of your return. 221
5000-S4

1 2 3 4 5 6 7

e e

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T1-2009

Details of Dependant

Schedule 5

See the guide to find out if you can claim an amount on lines 305, 306, 315, and/or 331 of Schedule 1. To calculate the amount you claim on line 306 or 315, complete the applicable chart on the federal worksheet, which you will find in the forms book. To calculate the amount for line 331, read the instructions for line 331 in the guide. For each dependant claimed on lines 305, 306, 315, and/or 331, 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 2009, give the date of the change. (Do not forget to tick the box on page 1 of your return to indicate your marital status.) Relationship Net income Last name Date of birth to you in 2009 First name Month Day Year Address

Nature of the impairment (if it applies)

Amount of claim

Lines 306, 315, and/or 331 ­ Attach a separate sheet of paper if you need more space.
Last name First name Address
Year of birth Relationship to you Net income in 2009 Nature of the impairment (if it applies) Line claimed Amount of claim

Last name First name Address
5000-S5

Year of birth

Relationship to you

Net income in 2009

Nature of the impairment (if it applies)

Line claimed

Amount of claim