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Personal Income Tax Return Form
Name:
Date of Birth:
Address:
Marital Status:
Single
Married
Widowed
Divorced
Separated
City / Prov / PC:
Spouse SIN:
Spouse Name:
Spouse SIN:
Telephone (H):
Telephone (B):
UP Date C/F:
CNIL
RRSP
Losses
CGE
Working Status:
Self Employed
Salaried
Commission
Did Not Work
Retired
Tax Paid by instalments?:
Rent Paid:
Property tax:
Became or ceased to be Canadian resident:
Date of death if deceased:
Notice of Assessment?
Income Sources
Status
Comments
T3
Yes
NO
N/A
T4/ T4A
Yes
NO
N/A
T4RSP
Yes
NO
N/A
T4E (EI Benifit)
Yes
NO
N/A
T5 ( interest income, dividends, CSB, cap gain )
Yes
NO
N/A
Taxable Capital Gain on sale of
?
Yes
NO
N/A
Commissions
Yes
NO
N/A
Other employment income
?
Yes
NO
N/A
Workers Compensation payments or Social Assistance before T5007 ( WSIB or Social Assistance )
Yes
NO
N/A
T4A(OAS)
Yes
NO
N/A
T4A(P) Canada Pension Plan benefits
Yes
NO
N/A
Other Pension
?
Yes
NO
N/A
Alimony income
Yes
NO
N/A
Rental income and expence - please attach
Yes
NO
N/A
Deductions / Expenses / Credits
Status
Comments
RRSP contribution ? attached notice of assessment
Yes
NO
N/A
Union or professional dues
Yes
NO
N/A
Child care expenses: amt. pd.
child
Yes
NO
N/A
Carrying charges (interest paid/safety dep. box.)
Yes
NO
N/A
Tuition fees/Education amount
Yes
NO
N/A
Medical receipts attached
Yes
NO
N/A
Disability credit (
)
Yes
NO
N/A
Transferable items (Age/Disability/Tuition/Pension)
Yes
NO
N/A
Donation/Political contributions
Yes
NO
N/A
Alimony payments
Yes
NO
N/A
Moving expenses
Yes
NO
N/A
Employment expenses - Attach T2200
Yes
NO
N/A
Business investment losses
Yes
NO
N/A
Losses to apply
Yes
NO
N/A
Capital gains deducation
Yes
NO
N/A
Other deducations/expenses/credits?
Yes
NO
N/A
DEPENDANTS
Name
DOB
SON/DTR
Net Income
Infirm ?
1
2
3
4
5
6
Rental Information
Period Cover:
Rental Income:
Expenses
Property Tax:
Interest:
Insurance:
Maintenance / Repairs:
Utilities:
Advertising:
Others:
Total Expenses:
Less Personal Use: ( in % )
NET RENTAL INCOME
Portion reported by taxpayer (%)
Portion reported by:
SIN
1
2
3
4
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