Free untitled - Canada

Canada Revenue Agency

Agence du revenu du Canada

T1044 E (05)

NON-PROFIT ORGANIZATION (NPO) INFORMATION RETURN NOTE: In this form, the text inserted between square brackets represents the regular print information. 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). 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. continue on next page
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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

Do not use this area

Section A ­ Identification
Fiscal period Year From Name of organization Month Day to Year Month Day

Mailing address

City

Province/Territory

Postal code

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Business Number (BN), if any (enter the first nine digits) Trust (T3) number, if any T 1 Yes 2 No

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

Area code Telephone number ­

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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) 106 Total receipts (add lines 100 to 106) 107 100 101 102 103 104 105

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

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Total assets (add lines 108 to 115)

116

Liabilities Amounts owing to members Amounts owing to all others (specify) 118 Total liabilities (add lines 117 and 118) 119 117

Section D ­ Remuneration
Total remuneration and benefits paid to all employees and officers Total remuneration and benefits paid to employees and officers who are members
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120 121

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.

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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

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Mailing address

City

Province/Territory

Postal code

Area code Telephone number ­

Section G ­ Certification
To be signed only by a current officer of the organization. Name of officer whose signature appears on page 10 [below] (print) I, City and Province , of

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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

Year

Month

Day

Language of correspondence Indicate the language of your choice 1 English Anglais

Langue de correspondance Indiquer la langue de votre choix 2 Français French

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