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APPLICATION FOR GST/HST PUBLIC SERVICE BODIES' REBATE AND GST SELF-GOVERNMENT REFUND
Public service bodies' rebate ­ Use this form to claim a rebate if you are a municipality, hospital authority, external supplier, facility operator, charity, public institution, or qualifying non-profit organization, or if you are a university, school authority, or public college that is established and operated other than for profit. To determine if you are eligible, and for instructions on how to complete this form, see Guide RC4034, GST/HST Public Service Bodies' Rebate. Self-government refund ­ Use this form if you are eligible to claim a self-government refund of the GST or the federal part of the HST under a self-government agreement. If you are a GST/HST registrant and you want to use the rebate to reduce an amount of GST/HST payable on your GST/HST return, you will have to complete Part C below. If you are not a GST/HST registrant, you can file an application for the first six months of your fiscal year, and another application for the last six months of your fiscal year. If you are resident in Sudbury/Nickel Belt, Toronto Centre, Toronto East, Toronto West, Toronto North, or Barrie, complete and send your form to: Canada Revenue Agency Sudbury Tax Centre 1050 Notre Dame Avenue Sudbury ON P3A 5C1 If you are resident anywhere else in Canada, complete and send your form to: Canada Revenue Agency Summerside Tax Centre 275 Pope Road, Suite 103 Summerside PE C1N 6A2

If you have questions about completing this form, go to www.cra.gc.ca/gsthst or call 1-800-565-9353. Please use black or blue ink when completing this form.

Part A ­ Identification
Business Number Name Operating/trade name (if different from name) Province Province Postal code Postal code

R T
Mailing address Physical location (if different from mailing address) Contact person Telephone number ­ ­ Charity registration number (if you are a registered charity) City City

What is your fiscal year-end?

Month

Day

R R

Part B ­ Claim period
Year Month Day to: Year Month Day

Period covered by this application:

From:

Part C ­ Offset on GST/HST return
This part applies to GST/HST registrants only. Is the amount on line 409 of this form being included on line 111 of your GST/HST return? . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Year Month No Day

If yes, enter the reporting period end date of your GST/HST return. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part D ­ Certification
I certify that the information given on this form and in any documents attached is, to the best of my knowledge, true, correct, and complete in every way. The amount on line 409 on this form or any part of it has not previously been claimed; books, records, and invoices are available for inspection; and I am authorized to sign for the organization.
Name (print) Signature Title Telephone number ­ Do not write in this area. IC NC ­ Year Month Day

GST66 E (10)

Vous pouvez obtenir ce formulaire en français à www.arc.gc.ca ou au 1-800-959-3376.

Part E ­ Details of claim
Enter on the appropriate line of the table below the amount of rebate that you are claiming for each activity that you perform. If you engage in various public service body activities, you may qualify for rebates at different percentages based on the extent to which you use eligible goods or services in each activity. For more information, see "Special rules for claimants with multiple activity types" in Guide RC4034, GST/HST Public Service Bodies' Rebate. GST and federal part of HST If you are claiming a rebate for the provincial part of the HST, you must also complete and attach Form RC7066 SCH, Provincial Schedule ­ GST/HST Public Service Bodies' Rebate. Line number 300 301 302 303 304 305 306 307 308 309 310 311 312 Municipality University (or affiliated college or research body) established and operated on a non-profit basis School authority established and operated on a non-profit basis Public college established and operated on a non-profit basis Hospital authority (only for activities related to operating a public hospital) Charity or public institution Qualifying non-profit organization ­ See Note 1 Printed books (do not include in other activity types) Goods and services exported by a charity or public institution Self-government refund Hospital (for eligible activities other than the operation of a public hospital) ­ See Note 2 Facility operator (for eligible activities) ­ See Note 2 External supplier (for eligible activities) ­ See Note 2 Activity type Rebate factor 100% 67% 68% 67% 83% 50% 50% 100% 100% 100% 83% 83% 83%
e e e e e e e e e e e e

Federal

Total federal claim (enter this amount on line A below) =

Total federal amount claimed Total provincial amount claimed (from Form RC7066 SCH) Total amount claimed (line A plus line B) 409
e

A B

=
Privacy Act, Personal Information Bank number CRA PPU 091

Notes 1. If you are a qualifying non-profit organization, you must complete and file Form GST523-1, Non-Profit Organizations ­ Government Funding, each year. Do not send us your annual reports or financial statements. 2. A rebate of 83% of the GST and the federal part of the HST is available for expenses incurred by eligible charities, public institutions, and qualifying non-profit organizations to the extent that they are also a facility operator or an external supplier. Hospital authorities are eligible for the rebate if their expenses are incurred in activities carried out in the course of operating a qualifying facility where facility supplies are made or to make facility supplies, ancillary supplies, or home medical supplies. For more information, go to www.cra.gc.ca/gsthst and select "Rebates" and then "Public service bodies' rebates."