Free t2093-04e.pdf - Canada

CONTRIBUTIONS TO A CANDIDATE AT AN ELECTION INFORMATION RETURN
To be completed by each official agent of a candidate at an election of a member or members to serve in the House of Commons of Canada, unless the appointment of such agent had been terminated prior to completion of the duties in respect of that particular election. One completed return is to be filed with the Charities Directorate, Canada Revenue Agency, Ottawa ON K1A 0L5, within four months after polling day, or if applicable within four months of the date of publication in the Canada Gazette of the notice of withdrawal or deemed withdrawal of the writ issued for the electoral district for which the candidate was nominated. A copy of each receipt signed by the official agent (or a predecessor official agent) for contributions to the candidate during the period covered by this return is to be retained by the official agent until the day that is two years after the end of the last calendar year to which the receipt relates, and must be available for inspection throughout that period. Identification
Name of Candidate Electoral District

Address of Candidate

Political Affiliation Name of Official Agent

Address of Official Agent

Period Covered by this Return
Year Month Day Year Month Day

DATE OF POLLING DAY Check ( ) applicable box and enter appropriate date

OR

DATE OF PUBLICATION OF WITHDRAWAL OF WRIT

From: The earlier of: (a) the date of appointment of the official agent of the candidate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . or (b) the date of appointment of predecessor official agent of that candidate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . To: One month after polling day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Year

Month

Day

Year

Month

Day

Year

Month

Day

Contributions Received
Before completing this part, please refer to the Canada Revenue Agency's Information Circular 75-2. Total amount of monetary contributions received during the period covered by this return. . . . . . . . . . . . . . . . . . . . . . . . . . Total eligible amount of monetary contributions received for which official receipts for income tax purposes were issued. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Difference: If the amount at (1) is greater than the amount at (2), please attach a reconciliation. . . . . . . . . . . . . . . . . . (1)

$
(2)

$
(3)

$

Questions
1. If replacement receipts were issued for spoiled receipts, or receipts were otherwise cancelled, were all original receipts returned to the official agent? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If no, please provide particulars: Yes No

2. If duplicate receipts were issued, were they in all cases issued to the original contributor? . . . . . . . . . . . . . . . . . . . . . . . . . . If no, please provide particulars:

Yes

No

Certification

I,
(Print Name of Official Agent)

hereby certify that I have not issued official tax

receipts for goods and/or services, and that the information given in this information return and in any documents attached is, to the best of my knowledge, correct and complete.
Signature of Official Agent Home telephone number Form authorized by the Minister of National Revenue (Français au verso) Business telephone number Date

T2093 (04)
Printed in Canada