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Personal Information Name Name of Spouse/Partner Name of dependants 1 Name of dependants 2 Name of dependants 3 Name of dependants 4 Address Street Province Email Marital status Is this a change in address from last year? Please provide a copy of your 2010 notice of assessment. Date of departure or entry into Canada (if within tax year) Date of marriage (if within tax year) Date of separation or divorce (if within tax year) Date of death Province of residency on December 31 Yes Are you a Canadian citizen? As a Canadian citizen, do you authorize CRA to provide your info to Elections Canada? Did you own foreign assets outside Canada in excess of $100,00 CDN during the year? (if yes, please provide description in notes below) Are you or your spouse a US citizen or a green card holder? Are you a first time homebuyer in the year? Are you claiming the disability deduction? (if this is first time attach signed T2201) Do you wish to split your pension income with your spouse, if applicable? Would you like to provide Ark authorization to speak to CRA on your behalf? Number of slips or note/comment Income Employment income - T4, T4PS Other employment income (description and amount) Old age security - T4A (OAS) Canada Pension - T4A(P) Pension or annuity income - T4A RRSP or RRIF withdrawal - T4RSP, T4RIF Foreign pension income - e.g. US social security Universal child care benefit - RC62 Employment insurance - T4E Alimony or child support payments received No Social Insurance Number Date of Birth D M Y
Amount
see business checklist see rental property checklist see capital gains checklist Number of slips or note/comment
Deductions RRSP deduction (provide slips from financial institutions) Annual union or professional dues (provide receipts) Support payments Safety deposit box fees Carrying charges and interest expense Clergy residence deduction Disability supports deduction Other deductions (provide details and amount) Other deductions (provide details and amount) Child care expenses (provide receipts) Business investment loss Moving expenses Motor vehicle expenses Home office expenses Commissioned employee expenses (provide T2200) Salaried employee expenses (provide T2200) Artists' employment expenses Transport employees
Amount
see T778 see capital gains checklist see T1-M see motor vehicle expense checklist see home office expense checklist see employment expense checklist see employment expense checklist see employment expense checklist see TL2 Number of slips or note/comment
Tax credits Adoption expense Caregiver amount Interest paid on student loans Volunteer firefighters' amount Public transit passes Children fitness amount Children's art amount Home buyer's amount Tuition amounts - T2201/T2202A
Amount