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This return is for: non-profit organizations (NPOs) described in paragraph 149(1)(l) of the Income Tax Act; and organizations described in paragraph 149(1)(e) of the Act (agricultural organizations, boards of trade or chambers of commerce).

NON-PROFIT ORGANIZATION (NPO) INFORMATION RETURN

Do not use this area

An organization may have to file this return if: it received or is entitled to receive taxable dividends, interest, rentals or royalties of more than $10,000 in the fiscal period; it owned assets valued at more than $200,000 at the end of the immediately preceding fiscal period; or it had to file a NPO return for a previous fiscal period. To determine if the organization you represent has to complete this return, please see the T4117, Income Tax Guide to the Non-Profit Organization (NPO) Information Return. Send your completed return to: Ottawa Technology Centre, 875 Heron Road, Ottawa ON K1A 1A2 Fiscal period
Year From Month Day

Section A ­ Identification
Year Month Day

to

Business Number (BN), if any (enter the first nine digits) Trust (T3) number, if any

Name of organization

T

Mailing address City Province Postal code

Is this the final return to be filed by this organization? If yes, attach an explanation. Type of organization (see the guide, T4117)

1 Yes

2 No

Name and title of person to contact Area code Telephone number

-

-

Section B ­ Amounts received during the fiscal period
Membership dues, fees, and assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Federal, provincial, and/or municipal grants and payments . . . . . . . . . . . . . . . . . . . . . . . Interest, taxable dividends, rentals, and royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Proceeds of disposition of capital property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gross sales and revenues from organizational activities. . . . . . . . . . . . . . . . . . . . . . . . . . Gifts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other receipts (specify) Total receipts (add lines 100 to 106) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 101 102 103 104 105 106 107

0.00

0.00

Assets

Section C ­ Statement of assets and liabilities at the end of the fiscal period
108 109 110 111 112 113 114 115 116

Method used to record assets Cash and short-term investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Amounts receivable from members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Amounts receivable from all others (not included on line 109) . . . . . . . . . . . . . . . . . . . . . Prepaid expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Long-term investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fixed assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other assets (specify) Total assets (add lines 108 to 115) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Liabilities Amounts owing to members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Amounts owing to all others (specify) Total liabilities (add lines 117 and 118) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T1044 E (05)

0.00

0.00

117 118 119

0.00

0.00

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

Section D ­ Remuneration
Total remuneration and benefits paid to all employees and officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 121 Total remuneration and benefits paid to employees and officers who are members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other payments to members (specify) 122

Number of members in the organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Number of members who received remuneration or other amounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section E ­ The organization's activities
Briefly describe the activities of the organization. If this is the organization's first year filing this return, attach a copy of the organization's Mission Statement.

Are any of the organization's activities carried on outside of Canada? If yes, indicate where:

1 Yes

2 No

Section F ­ Location of books and records
Leave this area blank if the information is the same as that in Section A
Name of person to contact

Mailing address

City

Province

Postal code

Area code

Telephone number

-

-

Section G ­ Certification
To be signed only by a current officer of the organization.

I,
Name of officer whose signature appears below (print)

, of
City and Province

,

certify that the information given on this return is, to the best of my knowledge, correct and complete.
Authorized officer's signature Position or office within the organization

Language of correspondence
Year Month Day

Langue de correspondance Indiquer la langue de votre choix

Date

Indicate the language of your choice

1
Printed in Canada

English Anglais

2

Français French