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APPLICATION TO REGISTER A CHARITY UNDER THE INCOME TAX ACT

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To complete this form, you will need the information and instructions in the companion Guide T4063, Registering A Charity For Income Tax Purposes (www.cra-arc.gc.ca/E/pub/tg/t4063/README.html). To evaluate an application, we need complete and accurate information. If a question is not relevant to the organization's situation, enter N/A in the space provided. If this application and the mandatory attachments are not included, we will return the application without reviewing it. See the checklist on the last page for a list of the mandatory attachments. The Canada Revenue Agency (CRA) may share the information collected on this form with other government departments or agencies to verify compliance with the Income Tax Act and other Acts of Parliament. The Privacy Act protects all personal information given on this form, which is kept in personal information bank: CRA PPU 200. If the application is approved and the organization is registered, the CRA is permitted to make this form (including any attachments) and copies of the registration letter (including any conditions and warnings contained therein) available to the public, with the exception of the confidential information in Part 5 and Part 6. If registration is denied, however, none of the information will be provided to the public.

Part 1 ­ Identification of the organization applying for registration
Q1 Current legal name of the organization

Q2 Current operating or trade name

N/A

Q3 Previous names ­ List any other names under which the organization has operated

N/A

Q4 Business Number Give one of the organization's Business Numbers if one has been assigned.

N/A

R C R P
Q5 Mailing address (number, street, room, floor or suite no., R.R.)

RM R T

(city or town)

(province)

(postal code)

(phone number) Q6 Previous contact with CRA Has the organization previously applied to be registered as a charity? Yes No

(fax number)

(Web site address)

If yes, provide the reference number(s) used by the Charities Directorate.

Business Number Submission Number

Do not use this area Reference number CTS Work Item Number

T2050 E (09)

(Ce formulaire est disponible en français)

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Part 1 ­ Identification of the organization applying for registration (cont'd)
Q7 Re-Registration See "What should an organization know about re-registration" in section I of Guide T4063 for information on the re-registration process and what should be submitted with this application. Has this organization ever been registered as a charity, under either its current name or a different name? Yes If yes, a) Under what name was the organization previously registered? b) Business Number of the organization at the time its charitable registration was revoked: No (Go to Q8)

R R

Part 2 ­ Organizational structure
Q8 Internal divisions of Canadian registered charities Is the organization a branch, section, parish, congregation, or other internal division of a Canadian registered charity (the parent organization)? Yes If yes, a) Legal name of parent organization: b) Business Number of the parent organization: c) Letter of Good Standing. (see "Part 2 ­ Organizational structure" in section II of Guide T4063) Q9 Governing documents See "Governing Documents" in section I of Guide T4063 for information on requirements. Is the organization incorporated? Yes (Go to Q9.1) Q9.1 Incorporated a) Incorporating documents Attach a copy of the entire set of incorporating documents, including all amendments. Attached b) By-laws If applicable, attach a copy of the by-laws and all amendments. Attached N/A No (Go to Q9.2) Attached No (Go to Q9)

R R

c) Certificate of good standing or its equivalent This is a required attachment if the organization has been incorporated for more than 5 years or if the organization is applying for re-registration. Attached N/A

Q9.2 Not incorporated a) Name the type of document that governs the organization, and attach a copy including all amendments and bylaws, if applicable. Constitution Trust Will Other (specify)

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Part 2 ­ Organizational structure (cont'd)
Q10 Designation a) Has the organization been formed to give more than 50% of its income to qualified donees (e.g., other Canadian registered charities)? Yes No

b) What percentage of the organization's officials listed in Q18 are not at arm's length with the other officials (e.g., related by blood, marriage, business or employer/employee relationships)? 50% or more are not at arm's length less than 50% are not at arm's length In the case of 50% or more, identify the relationships that exist among the organization's officials.

c) Has the organization received, or will it receive, more than 50% of its capital (e.g., funds or assets) from one person (i.e., individual, corporation, trust, unincorporated entity) or a group of persons who are not at arm's length with each other? Yes (Go to Q10 d)) No (Go to Q11)

d) 1. Identify the source of the funds or assets described in (c) and, if applicable, the relationships between the major contributors. See "Q10 Designation" in section II of Guide T4063 for a definition of major contributor.

d) 2. Will the major contributor(s), or anyone not at arm's length with the major contributor(s), have any ongoing involvement whatsoever with the organization? If yes, describe.

d) 3. Identify any personal or business relationships that exist between the organization's officials (e.g., directors/trustees) and the major contributor(s) or any person not at arm's length with the major contributor(s).

Part 3 ­ Activities of the organization
Q11 Charitable purposes and activities a) This section should be used to describe the organization's purpose(s) as outlined in its governing documents, and its corresponding activities (both actual and proposed). The purposes should be entered exactly as they appear in the organization's governing documents. Enter where each activity will take place, what it will involve, and who will carry it out, following the example set out below. Provide information on pages 4 and 5. (Purpose 1, 2, 3, etc.). If the activities will be carried on outside Canada, also see Q11 c). Record fundraising activities only at Q12. Example: Purpose ­ To relieve poverty by operating a soup kitchen. Activities in support of Purpose ­ The organization will operate a soup kitchen at 555 Any Street, Any Place, Canada. We will offer breakfast, lunch, and dinner 365 days a year. The facility is staffed by 4 volunteers and also provides clothing and other basic necessities to those in need. The soup kitchen's services are advertised at local churches and community centres.

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Charitable purposes and activities ­ Description Answers to Q. 11a
Provide a complete description of the activities to be carried out in support of each of the organization's purposes. If more space is required, please attach additional pages at the end of this form.

Reminder: If more space is required, please attach additional pages at the end of this form.

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Charitable purposes and activities ­ Description (cont'd) Answers to Q. 11a
Provide a complete description of the activities to be carried out in support of each of the organization's purposes. If more space is required, please attach additional pages at the end of this form.

Reminder: If more space is required, please attach additional pages at the end of this form.

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Part 3 ­ Activities of the organization (cont'd)
b) Is the organization currently carrying out any of the activities described in Q11 a)? Yes No

If no, when does the organization plan to begin operations?

c) Activities outside of Canada Are any of the organization's activities listed in Q11 a) taking place outside of Canada? Yes No

If yes, go to pages 7 and 8, give the location(s) and include a detailed description of how the organization will undertake these activities. If these activities will be conducted under an arrangement with another organization or individual, describe the arrangement, and attach copies of any current or proposed written arrangement. See "Q11 c) Activities Outside of Canada" in part 3 section II of Guide T4063 for more information. d) Attach all minutes of meetings, newspaper articles, videos, CDs, fundraising materials, pamphlets, brochures, or other items that further describe the organization's work and purposes. Attached Q12 Fundraising activities a) Describe the organization's fundraising activities. Include the fundraising method, the frequency of each event, and the percentage of people involved who are volunteers. Examples: 1. We will operate a silent auction 4 times per year. 95% of people involved are volunteers. 2. We will use the Internet and email solicitation as means of ongoing fundraising. No volunteers are involved in this activity. N/A

b) Has the organization hired, or does it plan to hire, a fundraiser from outside the organization to carry out the fundraising activities? Yes No

If yes, identify the fundraiser, the amount it will be compensated, the terms of payment (e.g. lump sum vs. percentage of gross revenue), and attach a copy of any current or proposed contracts.

c) Does the organization intend to receive non-cash gifts on a regular basis? Yes No

If yes, describe the nature of the non-cash gifts (e.g., art work).

d) Is the organization currently involved with, or have any plans to become involved with, or is in any way associated with a tax shelter arrangement? See "Q12 d) Fundraising Activities" in part 3 section II of Guide T4063 for a definition of a "tax shelter arrangement". Yes No

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Activities outside of Canada ­ Description Answers to Q. 11c
Provide a complete description of the activities the organization will undertake outside of Canada. If more space is required, please attach additional pages at the end of this form.

Reminder: If more space is required, please attach additional pages at the end of this form.

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Activities outside of Canada ­ Description (cont'd) Answers to Q. 11c
Provide a complete description of the activities the organization will undertake outside of Canada. If more space is required, please attach additional pages at the end of this form.

Reminder: If more space is required, please attach additional pages at the end of this form.

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Part 3 ­ Activities of the organization (cont'd)
Q13 Revenue from the sale of goods, services, or use of assets Does the organization plan to charge fees or receive regular income from the sale of goods or services, or from the use of the organization's assets? Example: The organization is an art gallery that operates a coffee shop in the facility for visitors to use. Yes If yes: a) Describe the activities in detail, and explain how these activities are linked to the organization's purpose(s). No (Go to Q14)

b) For each of the activities described in Q13 a), give the approximate percentage of the organization's total resources (human, financial, and physical) that it will devote to these activities.

c) What percentage of human resources involved are volunteers? % Q14 Political activities See "Political purposes" in section I of Guide T4063 for a definition of political activities. a) Does the organization intend to undertake any political activities? Letter-writing campaigns, public rallies, and advocacy are usually considered political in nature. Yes No (Go to Q15)

b) If yes, describe the political activities in detail. Include details about the frequency, and explain how these activities help to achieve the organization's purposes.

c) For each of the activities described in Q14 b), give the approximate percentage of the organization's total resources (human, financial, and physical) that it will devote to its political activities.

Q15 Financial transactions with the organization's officials Has the organization entered into, or does it intend to enter into, any financial, real estate, or other transactions with its officials (e.g. directors/ trustees), founders, members, employees, or any person/organization related to these people? Yes No

If yes, give a detailed description of these transactions.

Q16 Ownership a) Does the organization own more than 2% of the outstanding shares of any class of shares of a corporation? See part 3 section II of Guide T4063 at Q16 for an explanation of the terms used. Yes No

b) Does the organization currently own any real property, or does it have any future plans to own real property (e.g., land or buildings)? Yes No

If yes, on a separate page, provide the address (including the country) and a description of the current property and title-holder arrangements, and/or proposed title-holder arrangements for future property.

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Part 4 ­ Financial Information of the organization
Q17 Proposed budget All applicants must complete Part 4. Give a proposed operating budget of revenue and expenditures and a list of anticipated assets and liabilities for the organization. If the organization has been operating for more than one year, attach a copy of its most recent financial statements. Attached N/A Day

What is the organization's fiscal period end? Month

Proposed operating budget for the next fiscal period (covering 12-months) a) Revenue Gifts Gifts from individuals Gifts from corporations and businesses (give name if known) 001 002 Amount

Gifts from other registered charities (give name and Business Number if known)

003

Government grants, contributions, or contracts Fundraising activities (described in Q12) Fundraising activities carried on by the organization itself (report gross revenue) Fundraising carried on by fundraisers outside of the organization (report gross revenue)

004

005

006

Revenue from the sale of goods, services, or the use of assets (described in Q13)

007

Other List any other sources of revenue not already included above 008

Total estimated revenue from all sources (Add lines 001-008) 009

$0.00

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Part 4 ­ Financial Information of the organization (cont'd)
b) Expenditures Charitable activities (described in Q11) List each charitable activity (described in Q11a) and c)) 010 Amount

$0.00

Gifts to qualified donees (e.g., Canadian registered charities) Include the name and Business Number of the qualified donee

011

Fundraising activities (described in Q12) Expenditures incurred for fundraising carried on by the organization itself 012

Expenditures incurred for paying fundraisers outside of the organization

013

Expenditures related to the sale of goods, services, or the use of assets (described in Q13) Expenditures incurred for political activities (described in Q14)

014 015

Management and administration Remuneration (e.g., salaries, benefits) not already included Accounting and legal services Occupancy costs not already included Supplies and equipment not already included Printing, publications, and advertising not already included Travel not already included 016 017 018 019 020 021

Other List any other expenditure not already included above 022

Total estimated expenditures (Add lines 010 to 022) 023

$0.00

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Part 4 ­ Financial Information of the organization (cont'd)
c) Revenue and expenditures outside of Canada Revenue Is any of the organization's estimated revenue included in Q17 a) received from donors outside of Canada? Yes No

If yes, list the source of revenue and total estimated amount. Source of revenue Amount

Expenditures Will any of the organization's estimated expenditures included in Q17 b) be incurred for activities outside of Canada? Yes No

If yes, list the country, corresponding activity (described in Q11 a) & Q11 c)) and the estimated amount. Country (including region) Activity/Recipient Amount

d) Assets and Liabilities Revenue See Q17 d) "Assets and Liabilities" in part 4 section II of Guide T4063 for more information. Assets Enter the cost of the asset or, if the asset was donated, enter the fair market value. Cash, bank accounts, and short term investments Long-term investments Capital assets (e.g., equipment, buildings) Specify: Liabilities Amounts payable (e.g., accounts payable, mortgages, loans) 030 031 Specify:

032 Total assets (Add lines 030-032) Total liabilities 033 034

$0.00

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Part 5 ­ Information about the organization's officials
Q18 Your organization is required to provide certain information about all members of its board of directors/trustees. Only the public information section is available to the public. The confidential information section is for the CRA's use and may only be disclosed in accordance with the provisions of the Income Tax Act. If more space is required, photocopy this page and attach it to the application form. Public information Last name First name Initial Confidential information Street number and name City

Position in charity President Treasurer Other Last name First name Initial Secretary Chair Vice-President Executive Director

Province or territory

Postal code

Telephone number

Occupation / line of work

Date of birth (YYYY/MM/DD)

Street number and name

City

Position in charity President Treasurer Other Last name First name Initial Secretary Chair Vice-President Executive Director

Province or territory

Postal code

Telephone number

Occupation / line of work

Date of birth (YYYY/MM/DD)

Street number and name

City

Position in charity President Treasurer Other Last name First name Initial Secretary Chair Vice-President Executive Director

Province or territory

Postal code

Telephone number

Occupation / line of work

Date of birth (YYYY/MM/DD)

Street number and name

City

Position in charity President Treasurer Other Last name First name Initial Secretary Chair Vice-President Executive Director

Province or territory

Postal code

Telephone number

Occupation / line of work

Date of birth (YYYY/MM/DD)

Street number and name

City

Position in charity President Treasurer Other Last name First name Initial Secretary Chair Vice-President Executive Director

Province or territory

Postal code

Telephone number

Occupation / line of work

Date of birth (YYYY/MM/DD)

Street number and name

City

Position in charity President Treasurer Other Last name First name Initial Secretary Chair Vice-President Executive Director

Province or territory

Postal code

Telephone number

Occupation / line of work

Date of birth (YYYY/MM/DD)

Street number and name

City

Position in charity President Treasurer Other Secretary Chair Vice-President Executive Director

Province or territory

Postal code

Telephone number

Occupation / line of work

Date of birth (YYYY/MM/DD)

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Part 6 ­ Confidential Information
Q19 Physical location of the organization Same as mailing address (Q5) or:

(Number, street, room, floor or suite no., lot no., concession)

(City or town, province, and postal code)

(Phone number)

(Fax number)

Q20 Physical location of books and records Same as mailing address (Q5) or: Same as physical location in (Q19) or:

(Number, street, room, floor or suite no., lot no., concession)

(City or town, province, and postal code)

(Phone number)

(Fax number)

Q21 Authorized Representative/Contact Person Name
(first name, initial, surname)

Full mailing address

(Number, street, room, floor or suite no., lot no., concession)

(City or town, province, and postal code)

(Phone number)

(Fax number)

Part 7 ­ Final Steps and Certification
Checklist Have you attached the following information to this application? a copy of the governing documents and a copy of all the amendments, if applicable (see Q9.1). If the organization is governed by a constitution, remember to have the document signed and dated by three current directors (see Q9.2); a copy of the by-laws, if any (see Q9.1 or Q9.2); the parent organization's Letter of Good Standing; a certificate of good standing, if applicable (see Q9.1 c)); a detailed description of each purpose and its corresponding activities (see Q11 a) & Q11 c)); a copy of the minutes, newspaper clippings, pamphlets, fundraising materials (see Q11 d)); a copy of the latest financial statements, if applicable (see Q17); the $500 late-filing penalty, if applicable (see Q7 and the related information in section I of Guide T4063); and if applicable, all missing T3010, Registered Charity Information Returns, and required attachments (see Q7 and the related information in section I of Guide T4063).

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Part 7 ­ Final Steps and Certification (cont'd)
Certification This form must be signed by two directors/trustees or like officials of the organization who have authority to sign on behalf of the organization. It is a serious offence under the Income Tax Act to provide false or deceptive information. I certify that the information given on this form and any attachment is, to the best of my knowledge, correct, complete, and current.
Signature Name (please print) Position within the organization Date signed 1. 2.

Electronic mailing list (EML) Subscribers to the Charities What's New electronic mailing list are automatically notified by email of the latest information available for charities on such things as the Charities Information Sessions, new policies, updated policies, the Registered Charities Newsletter, and the Charities Partnership and Outreach Program. Subscribers will receive 2 emails a month from the Charities Directorate. The Charities Directorate will subscribe the following email addresses for the electronic mailing list service.

Give your preferred email addresses:

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Once completed, mail this application to: Charities Directorate Canada Revenue Agency Ottawa ON K1A 0L5