5006-R (Page 1 of 4) Canada Revenue Agency T1 GENERAL 2011 Income Tax and Benefit Return Complete all the sections that apply to you in order to benefit from amounts to which you are entitled. For more information, see the guide. ON Code: 1 Identification Attach your personal label here. Correct any wrong information. If you are not attaching a label, print your name and address below. First name and initial ^ Last name ^ Mailing address: Apartment Number - Street Number Street name ^ Post Office Box ^ Rural Route ^ City ^ Province/Territory ^ Postal code ^ Information about your residence Enter your province or territory of residence on December 31, 2011: ^ Enter the province or territory where you currently reside if it is not the same as your mailing address above: ^ If you were self-employed in 2011, enter the province or territory of self- employment: ^ If you became or ceased to be a resident of Canada for income tax purposes in 2011, enter the date of: Entry (Month/Day) ^ or departure (Month/Day) ^ Information about you Enter your social insurance number (SIN) if it is not on the label or if you are not attaching a label: (enter 9-digit number) ^ Enter your date of birth: (Year/Month/Day) ^ Your language of correspondence: Votre langue de correspondance: English or Français ^ Marital status Tick the box (enter yes) that applies to your marital status on December 31, 2011: Box 1: Married ^ Box 2: Living common-law ^ Box 3: Widowed ^ Box 4: Divorced ^ Box 5: Separated ^ Box 6: Single ^ Information about your spouse or common-law partner (if you ticked box 1 or 2 above) Enter his or her SIN if it is not on the label or if you are not attaching a label: (enter 9-digit number) ^ Enter his or her first name: ^ Enter his or her net income for 2011 to claim certain credits: ^ Enter the amount of Universal Child Care Benefit (UCCB) from line 117 of his or her return: ^ Enter the amount of UCCB repayment from line 213 of his or her return: Tick this box (enter yes) if he or she was self-employed in 2011: Box 1 ^ Person deceased in 2011 If this return is for a deceased person, enter the date of death: (Year/Month/Day) ^ Do not use this area Elections Canada (see the Elections Canada page in the tax guide for details or visit www.elections.ca) A) Are you a Canadian citizen? 1 Yes or 2 No ^ Answer the following question only if you are a Canadian citizen. B) As a Canadian citizen, do you authorize the Canada Revenue Agency to give your name, address, date of birth, and citizenship to Elections Canada to update the National Register of Electors? 1 Yes or 2 No ^ Your authorization is valid until you file your next return. Your information will only be used for purposes permitted under the Canada Elections Act, which include sharing the information with provincial/territorial election agencies, members of Parliament and registered political parties, as well as candidates at election time. Goods and services tax/harmonized sales tax (GST/HST) credit application See the guide for details. Are you applying for the GST/HST credit or the Ontario Sales Tax Credit? 1 Yes or 2 No ^ Do not use this area Box 172 Box 171 5000-R (Page 2 of 4) The guide contains valuable information to help you complete your return. When you come to a line on the return that applies to you, go to the line number in the guide for more information. Please answer the following question: Box 266: Did you own or hold foreign property at any time in 2011 with a total cost of more than CAN$100,000? (see the "Foreign income" section in the guide for details) 1 Yes or 2 No ^ If yes, complete and attach Form T1135 to your return. If you had dealings with a non-resident trust or corporation in 2011, see the "Foreign income" section in the guide. As a resident of Canada, you have to report your income from all sources both inside and outside Canada. Total income Line 101: Employment income (box 14 of all T4 slips) ^ Line 102: Commissions included on line 101 (box 42 of all T4 slips) ^ Line 104: Other employment income ^ Line 113: Old Age Security pension (box 18 of the T4A(OAS) slip) ^ Line 114: CPP or QPP benefits (box 20 of the T4A(P) slip) ^ Line 152 Disability benefits included on line 114 (box 16 of the T4A(P) slip) ^ Line 115: Other pensions or superannuation ^ Line 116: Elected split-pension amount (attach Form T1032) ^ Line 117: Universal Child Care Benefit (UCCB) ^ Line 185: UCCB amount designated to a dependant ^ Line 119: Employment Insurance and other benefits (box 14 of the T4E slip) ^ Line 120: Taxable amount of dividends (eligible and other than eligible) from taxable Canadian corporations (attach Schedule 4) ^ Line 180: Taxable amount of dividends other than eligible dividends, included on line 120, from taxable Canadian corporations ^ Line 121: Interest and other investment income (attach Schedule 4) ^ Line 122: Net partnership income: limited or non-active partners only (attach Schedule 4) ^ Line 125: Registered disability savings plan income ^ Rental income Line 160: Gross ^ Line 126 Net ^ Line 127: Taxable capital gains (attach Schedule 3) ^ Support payments received Line 156: Total ^ Line 128: Taxable amount ^ Line 129: RRSP income (from all T4RSP slips) ^ Line 130: Other income ^ Specify: ^ Self-employment income Business income Line 162: Gross ^ Line 135: Net ^ Professional income Line 164: Gross ^ Line 137: Net ^ Commission income Line 166: Gross ^ Line 139: Net ^ Farming income Line 168: Gross ^ Line 141: Net ^ Fishing income Line 170: Gross ^ Line 143: Net ^ Line 144: Workers' compensation benefits (box 10 of the T5007 slip) ^ Line 145: Social assistance payments ^ Line 146: Net federal supplements (box 21 of the T4A(OAS) slip) ^ Line 147: Add lines 144, 145, and 146 (see Line 250 in the guide). = ^ Line 150: Add lines 101, 104 to 143, and 147. This is your total income. = ^ 5000-R (Page 3 of 4) Attach your Schedule 1 (federal tax) and Form 428 (provincial or territorial tax) here. Also attach here any other schedules, information slips, forms, receipts, and documents that you need to include with your return. Net income Line 150: Enter your total income from line 150. ^ Line 206: Pension adjustment (box 52 of all T4 slips and box 034 of all T4A slips) ^ Line 207: Registered pension plan deduction (box 20 of all T4 slips and box 032 of all T4A slips) ^ Line 208: RRSP deduction (see Schedule 7, and attach receipts) ^ Line 210: Deduction for elected split-pension amount (attach Form T1032) ^ Line 212: Annual union, professional, or like dues (box 44 of all T4 slips, and receipts) ^ Line 213: Universal Child Care Benefit repayment (box 12 of all RC62 slips) ^ Line 214: Child care expenses (attach Form T778) ^ Line 215: Disability supports deduction ^ Business investment loss Line 228: Gross ^ Line 217: Allowable deduction ^ Line 219: Moving expenses ^ Support payments made Line 230: Total ^ Line 220: Allowable deduction ^ Line 221: Carrying charges and interest expenses (attach Schedule 4) ^ Line 222: Deduction for CPP or QPP contributions on self-employment and other earnings (attach Schedule 8) ^ Line 224: Exploration and development expenses (attach Form T1229) ^ Line 229: Other employment expenses ^ Line 231: Clergy residence deduction ^ Line 232: Other deductions ^ Specify: ^ Line 233: Add lines 207 to 224, 229, 231, and 232. ^ Line 234: Line 150 minus line 233 (if negative, enter "0") This is your net income before adjustments. = ^ Line 235: Social benefits repayment (if you reported income on line 113, 119, or 146, see Line 235 in the guide). Use the federal worksheet to calculate your repayment. ^ Line 236: Line 234 minus line 235 (if negative, enter "0") If you have a spouse or common-law partner, see Line 236 in the guide. This is your net income. = ^ Taxable income Line 244: Canadian Forces personnel and police deduction (box 43 of all T4 slips) ^ Line 248: Employee home relocation loan deduction (box 37 of all T4 slips) ^ Line 249: Security options deductions ^ Line 250: Other payments deduction (if you reported income on line 147, see Line 250 in the guide) ^ Line 251: Limited partnership losses of other years ^ Line 252: Non-capital losses of other years ^ Line 253: Net capital losses of other years ^ Line 254: Capital gains deduction ^ Line 255: Northern residents deductions (attach Form T2222) ^ Line 256: Additional deductions ^ Specify: ^ Line 257: Add lines 244 to 256. = ^ Line 260: Line 236 minus line 257 (if negative, enter "0") This is your taxable income. = ^ Use your taxable income to calculate your federal tax on Schedule 1 and your provincial or territorial tax on Form 428. 5006-R (Page 4 of 4) Refund or balance owing Line 420: Net federal tax: enter the amount from line 58 of Schedule 1 (attach Schedule 1, even if the result is "0") ^ Line 421: CPP contributions payable on self-employment and other earnings (attach Schedule 8) ^ Line 430: Employment Insurance premiums payable on self-employment and other eligible earnings (attach Schedule 13) ^ Line 422: Social benefits repayment (amount from line 235) ^ Line 428: Provincial or territorial tax (attach Form 428, even if the result is "0") ^ Line 435: Add lines 420, 421, 430, 422, and 428. This is your total payable. = ^ Line 437: Total income tax deducted ^ Line 440: Refundable Quebec abatement ^ Line 448: CPP overpayment (enter your excess contributions) ^ Line 450: Employment Insurance overpayment (enter your excess contributions) ^ Line 452: Refundable medical expense supplement (use the federal worksheet) ^ Line 453: Working Income Tax Benefit (WITB) (attach Schedule 6) ^ Line 454: Refund of investment tax credit (attach Form T2038(IND)) ^ Line 456: Part XII.2 trust tax credit (box 38 of all T3 slips) ^ Line 457: Employee and partner GST/HST rebate (attach Form GST370) ^ Line 476: Tax paid by instalments ^ Line 479: Provincial or territorial credits (attach Form 479 if it applies) ^ Line 482: Add lines 437 to 479. These are your total credits. = ^ Line 435 minus line 482 This is your refund or balance owing. = ^ If the result is negative, you have a refund. If the result is positive, you have a balance owing. Enter the amount below on whichever line applies. Generally, we do not charge or refund a difference of $2 or less. Line 484: Refund ^ Line 485: Balance owing ^ Line 486: Amount enclosed ^ Attach to page 1 a cheque or money order payable to the Receiver General, or make your payment online (go to www.cra.gc.ca/mypayment). Your payment is due no later than April 30, 2012. Direct deposit - Start or change (see Line 484 in the guide) You do not have to complete this area every year. Do not complete it this year if your direct deposit information has not changed. Income tax refund, GST/HST credit, WITB advance payments, and any other deemed overpayment of tax - To start direct deposit or to change account information, complete lines 460, 461, and 462 below. Notes: To deposit your CCTB payments (including certain related provincial or territorial payments) into the same account, also tick box 463. To deposit your UCCB payments into the same account, also tick box 491. Line 460: Branch number (5 digits) ^ Line 461: Institution number (3 digits) ^ Line 462: Account number (maximum 12 digits) ^ Box 463: CCTB (Canada Child Tax Benefit) ^ Box 491: UCCB (Universal Child Care Benefit) ^ Ontario Opportunities Fund You can help reduce Ontario's debt by completing this area to donate some or all of your 2011 refund to the Ontario Opportunities Fund. Please see the provincial pages for details. Line 1: Amount from line 484 above ^ Line 2 and line 465: Your donation to the Ontario Opportunities Fund ^ Line 3 and line 466: Net refund (line 1 minus line 2) = ^ I certify that the information given on this return and in any documents attached is correct, complete, and fully discloses all my income. Sign here (It is a serious offence to make a false return.) ^ Telephone (including area code) ^ Date (Year/Month/Day) ^ Line 490: For professional tax preparers only Name: ^ Address: ^ Telephone (including area code): ^ Do not use this area Box 487 Box 488 Privacy Act, Personal Information Bank number CRA PPU 005