Free untitled - Canada

SUPPLEMENTARY UNEMPLOYMENT BENEFIT PLAN INCOME TAX RETURN
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As trustee for a trust governed by a supplementary unemployment benefit plan, you have to complete and file this form no later than 90 days after the end of the tax year. The tax year of the trust is the calendar year. Note: When a trustee responsible for filing this return does not act as administrator of the supplementary unemployment benefit plan, the trustee is still responsible for obtaining and reporting the required information. If the plan is not registered under the Income Tax Act throughout its period of operation or existence during the tax year, the income of the trust may be subject to tax. To report taxable income or claim a Part XII.2 tax credit, complete a T3 Trust Income Tax and Information Return. You can get a copy of the publication T4013, T3 Trust Guide and the T3 Trust Forms Package from our Web site at www.cra.gc.ca. Send the completed return to: Ottawa Technology Centre, 875 Heron Road, Ottawa ON K1A 1A2. We may impose penalties if this return is not filed on time. We charge interest at the prescribed rates on any amounts owing.
Account number (if one has been assigned)

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Name of plan

T
Name of trustee filing this return
Plan registration number

Mailing address of trustee

Address where the trust keeps its books and records (if different from address above)

Names of other trustees

Province or territory of residence of the plan

came into existence
(effective date of registration)

ceased to exist

Return for tax year

Date the trust:
Year Month Day Year Month Day

Tax under subsection 207.1(5) on agreements to acquire shares
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Complete Form T2000, Calculation of Tax on Agreements to Acquire Shares, if the trust entered into an agreement (other than for the acquisition, or the writing by it, of an option listed on a designated stock exchange) to acquire a share of the capital stock of a corporation (other than from the corporation) at a price that may differ from the fair market value at the time the share was acquired. Attach the completed Form T2000 to this return and enter the calculated amount on line 1. Tax on agreements to acquire shares Enter this amount on line 2.

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241

1

Summary of tax or refund Tax under subsection 207.1(5) on agreements to acquire shares (line 1) . . . . . . . . . . . . . . . . . . . . . Minus: Payments on account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Balance owing or refund (line 2 minus line 3) Generally, we do not charge or refund $2 or less.

140 010 090 095
­ =

2 3 4 5

Amount enclosed
Payment: Attach a cheque or money order payable to the Receiver General. Do not mail cash.

Certification I,
(Print name)

, of
(Address)

certify that the information given in this return is, to the best of my knowledge, correct and complete.

Signature of trustee or trust company official

Position or office if trustee is a corporation

Telephone number

Date

T3S E (09)

(Ce formulaire est disponible en français.)