Free untitled - Canada

File Size: 92.9 kB
Pages: 23
Date: October 28, 2009
File Format: PDF
State: Canada
Category: Tax Forms
Word Count: 1,875 Words, 11,617 Characters
Page Size: Letter (8 1/2" x 11")

Download untitled ( 92.9 kB)

Preview untitled
Canada Revenue Agency

Agence du revenu du Canada


Income Tax and Benefit Return
Complete all the sections that apply to you in order to benefit from amounts to which you are entitled.

Attach your personal label here. Correct any wrong information. If you are not attaching a label, print your name and address below. First name and initial


Last name

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

P.O. Box, R.R.



Postal code

5000-R ­ 1

continue on next page

Information about your residence Enter your province or territory of residence on December 31, 2009:

Enter the province or territory where you currently reside if it is not the same as that shown on page 1 [above] for your mailing address:

If you were self-employed in 2009, enter the province or territory of self-employment:

If you became or ceased to be a resident of Canada in 2009, give the date of: Month entry Day or departure
5000-R ­ 2



Information about you Enter your social insurance number (SIN) if it is not on the label, or if you are not attaching a label: Social Insurance Number

Year Enter your date of birth: Your language of correspondence: Votre langue de correspondance : English Français



Tick the box that applies to your marital status on December 31, 2009: (see the "Marital status" section in the guide) 1 4 Married Divorced 2 5 Living common-law Separated 3 6 Widowed Single

continue on next page
5000-R ­ 3

Information about your spouse or common-law partner (if you ticked box 1 or 2 on page 3 [above] ) (see the guide for more information) Enter his or her SIN if it is not on the label, or if you are not attaching a label: Enter his or her first name: Enter his or her net income for 2009 to claim certain credits: Enter the amount of Universal Child Care Benefit included on line 117 of his or her return: Enter the amount of Universal Child Care Benefit repayment included on line 213 of his or her return: Tick this box if he or she was self-employed in 2009: 1 Social Insurance Number

5000-R ­ 4

Person deceased in 2009 If this return is for a deceased person, enter the date of death: Do not use this area Year Month Day

Elections Canada (see the Elections Canada page in
the tax guide for details or visit A) Are you a Canadian citizen? Yes 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?





5000-R ­ 5

continue on next page

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? Do not use this area 172 171 Yes 1 No 2

5000-R ­ 6

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. 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 the "Foreign income" section in the guide for details) 266 Yes 1 No 2

If yes, attach a completed Form T1135. If you had dealings with a non-resident trust or corporation in 2009, see the "Foreign income" section in the guide. As a Canadian resident, you have to report your income from all sources both inside and outside Canada.

continue on next page
5000-R ­ 7

Total income
Employment income (box 14 on all T4 slips) Commissions included on line 101 (box 42 on all T4 slips) Other employment income Old Age Security pension (box 18 on the T4A(OAS) slip) CPP or QPP benefits (box 20 on the T4A(P) slip) Disability benefits included on line 114 (box 16 on the T4A(P) slip) Other pensions or superannuation Elected split-pension amount (see the guide and attach Form T1032) Universal Child Care Benefit (see the guide) 152 115 + 116 + 117 + 102 104 + 113 + 114 + 101

5000-R ­ 8

Employment Insurance and other benefits (box 14 on the T4E slip) Taxable amount of dividends (eligible and other than eligible) from taxable Canadian corporations (see the guide and attach Schedule 4) Taxable amount of dividends other than eligible dividends, included on line 120, from taxable Canadian corporations Interest and other investment income (attach Schedule 4) Net partnership income: limited or non-active partners only (attach Schedule 4) Registered disability savings plan income (see the guide) Rental income Rental income Gross 160

119 +

120 +

180 121 + 122 + 125 +

Net 126 + continue on next page
5000-R ­ 9

Taxable capital gains (attach Schedule 3) Support payments received Support payments received Other income ­ Specify: Self-employment income (see lines 135 to 143 in the guide) Business income Business income Professional income Professional income Commission income Commission income
5000-R ­ 10

127 + Total 156

Taxable amount 128 + 129 + 130 +

RRSP income (from all T4RSP slips)

Gross 162 Net 135 + Gross 164 Net 137 + Gross 166 Net 139 +

Farming income Farming income Fishing income Fishing income Workers' compensation benefits (box 10 on the T5007 slip) Social assistance payments Net federal supplements (box 21 on the T4A(OAS) slip) Add lines 144, 145, and 146 (see line 250 in the guide).

Gross 168 Net 141 + Gross 170 Net 144 145 + 146 + 143 +

147 + 150 = continue on next page
5000-R ­ 11

Add lines 101, 104 to 143, and 147. This is your total income.

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 income
Enter your total income from line 150. Pension adjustment (box 52 on all T4 slips and box 34 on all T4A slips) Registered pension plan deduction (box 20 on all T4 slips and box 32 on all T4A slips) RRSP deduction (see Schedule 7 and attach receipts) Saskatchewan Pension Plan deduction (maximum $600) 206 150

207 208 + 209 + 210 +

Deduction for elected split-pension amount (see the guide and attach Form T1032)
5000-R ­ 12

Annual union, professional, or like dues (box 44 on all T4 slips, and receipts) Universal Child Care Benefit repayment (box 12 on all RC62 slips) Child care expenses (attach Form T778) Disability supports deduction Business investment loss Business investment loss Moving expenses Support payments made Support payments made Total 230 Gross 228

212 + 213 + 214 + 215 +

Allowable deduction

217 + 219 +

Allowable deduction

220 + 221 +

Carrying charges and interest expenses (attach Schedule 4)

continue on next page
5000-R ­ 13

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: Add lines 207 to 224, 229, 231, and 232.



224 + 229 + 231 + 232 + 233 =

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.
5000-R ­ 14

234 =

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.

236 =

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)
5000-R ­ 15

244 248 + 249 + 250 + 251 + 252 + 253 + 254 + 255 +

continue on next page

Additional deductions Specify: Add lines 244 to 256.

256 + 257 =

Line 236 minus line 257 (if negative, enter "0") This is your taxable income. 260 =

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

5000-R ­ 16

Refund or balance owing
Net federal tax: enter the amount from line 55 of Schedule 1 (attach Schedule 1, even if the result is "0") CPP contributions payable on self-employment and other earnings (attach Schedule 8) Social benefits repayment (enter the amount from line 235) Provincial or territorial tax (attach Form 428, even if the result is "0") Add lines 420 to 428. This is your total payable. Total income tax deducted (see the guide) Refundable Quebec abatement 437 440 +

420 421 + 422 + 428 + 435 =

continue on next page
5000-R ­ 17

CPP overpayment (enter your excess contributions) Employment Insurance overpayment (enter your excess contributions) Refundable medical expense supplement (use 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) Tax paid by instalments Provincial or territorial credits (attach Form 479 if it applies)

448 + 450 + 452 + 453 + 454 + 456 + 457 + 476 + 479 +

5000-R ­ 18

Add lines 437 to 479. These are your total credits.

482 =

Line 435 minus line 482


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.

Refund 484 (see line 485 in the guide) 485

Balance owing

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.
5000-R ­ 19

continue on next page

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. Refund, GST/HST credit, WITB advance payments, and any other deemed overpayment of tax ­ To start direct deposit or to change 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 460 (5 digits) 462
5000-R ­ 20

Institution number 461 (3 digits) CCTB 463 UCCB 491

Account number (maximum 12 digits)

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. Area code Telephone number ­ Year Month Day

continue on next page
5000-R ­ 21

490 For professional tax preparers only Name




Postal code

Area code Telephone number ­

5000-R ­ 22

Do not use this area 487 488

"Privacy Act" Personal Information Bank number CRA PPU 005
5000-R ­ 23