*** Transcriber's Note: Please set your voice synthesizer to read most punctuation. When you encounter the caret sign at the end of a line, please enter the applicable information, if necessary. *** Canada Revenue Agency T1170 (11) CAPITAL GAINS ON GIFTS OF CERTAIN CAPITAL PROPERTY Use this form if, in 2011, you donated any of the following types of properties to a registered charity or other qualified donee: - a share, debt obligation, or right listed on a designated stock exchange*; - a share of the capital stock of a mutual fund corporation; - a unit of a mutual fund trust; - a prescribed debt obligation; - an interest in a related segregated fund trust; or - ecologically sensitive land (including a covenant, an easement, or in the case of land in Quebec, a real servitude)**. Under proposed changes, if there is no advantage in respect of the gift, the full amount of the capital gain realized on the gift is eligible for an inclusion rate of zero. However, if there is an advantage, only a portion of the capital gain is eligible for the inclusion rate of zero. The remainder is subject to an inclusion rate of 50%. For more information, see Pamphlet P113, Gifts and Income Tax. Under proposed changes, if you donate property to a qualified donee after March 21, 2011, that is at the time of the donation included in a flow-through share class of property, and at that time you have an exemption threshold in respect of the flow-through share class of property, you may be deemed to have an additional capital gain from the disposition of another capital property subject to an inclusion rate of 50%. For more information, see Pamphlet P113. * An inclusion rate of zero may be applied to any capital gain realized on the exchange of shares of the capital stock of a corporation for publicly listed securities that are then donated. See Pamphlet P113, Gifts and Income Tax, for conditions that must be met in order to be eligible for this treatment. In cases where the exchanged property is a partnership interest (other than a prescribed interest in a partnership), a special calculation is required to determine what the capital gain will be. This amount should be reported directly at line 174 of Schedule 3. For more information on this calculation, see Pamphlet P113. ** For donations of ecologically sensitive land to a private foundation, the inclusion rate of zero does not apply. You or your spouse or common-law partner may be able to claim a non-refundable tax credit for these gifts. For more information, see Pamphlet P113, Gifts and Income Tax. Include this form with your return. If you need more space, attach a separate sheet of paper. Dispositions in 2011 Publicly traded shares, other shares and mutual fund units *** Transcribers' Note: Enter as many lines as necessary for the following. In print, you have the possibility of up to 3 entry lines, we have indicated only two. *** First Line: Number ^ Name of fund/corporation and class of shares ^ Column (1) Year of acquisition ^ Column (2) Proceeds of disposition ^ Column (3) Adjusted cost base ^ Column (4) Outlays and expenses Column (from dispositions) ^ Column (5) Gain Column (column 2 minus columns 3 and 4) ^ Column (6) Eligible amount of gift ^ Column (7) Gain eligible for 0% inclusion rate Column (column 5 multiplied by column 6 divided by column 2) ^ Column (8) Gain subject to 50% inclusion rate Column (column 5 minus column 7) ^ Second Line: Number ^ Name of fund/corporation and class of shares ^ Column (1) Year of acquisition ^ Column (2) Proceeds of disposition ^ Column (3) Adjusted cost base ^ Column (4) Outlays and expenses Column (from dispositions) ^ Column (5) Gain Column (column 2 minus columns 3 and 4) ^ Column (6) Eligible amount of gift ^ Column (7) Gain eligible for 0% inclusion rate Column (column 5 multiplied by column 6 divided by column 2) ^ Column (8) Gain subject to 50% inclusion rate Column (column 5 minus column 7) ^ Line 6822: Total (add all entries for column 2) = ^ Line 6823: Total (add all entries for column 7) = ^ Line 1: Total (add all entries for column 8) (See note) = ^ Bonds, debentures, promissory notes, and other properties (including ecologically sensitive land) First Line: Face value ^ Maturity date ^ Name of issuer ^ Column (1) Year of acquisition ^ Column (2) Proceeds of disposition ^ Column (3) Adjusted cost base ^ Column (4) Outlays and expenses Column (from dispositions) ^ Column (5) Gain Column (column 2 minus columns 3 and 4) ^ Column (6) Eligible amount of gift ^ Column (7) Gain eligible for 0% inclusion rate Column (column 5 multiplied by column 6 divided by column 2) ^ Column (8) Gain subject to 50% inclusion rate Column (column 5 minus column 7) ^ Address or legal description of land ^ Line 6824: Total (add all entries for column 2) = ^ Line 6825: Total (add all entries for column 7) = ^ Line 2: Total (add all entries for column 8) (see note) = ^ Second Line: Face value ^ Maturity date ^ Name of issuer ^ Column (1) Year of acquisition ^ Column (2) Proceeds of disposition ^ Column (3) Adjusted cost base ^ Column (4) Outlays and expenses Column (from dispositions) ^ Column (5) Gain Column (column 2 minus columns 3 and 4) ^ Column (6) Eligible amount of gift ^ Column (7) Gain eligible for 0% inclusion rate Column (column 5 multiplied by column 6 divided by column 2) ^ Column (8) Gain subject to 50% inclusion rate Column (column 5 minus column 7) ^ Address or legal description of land ^ Line 6824: Total (add all entries for column 2) = ^ Line 6825: Total (add all entries for column 7) = ^ Line 2: Total (add all entries for column 8) (see note) = ^ Note: Include the amount from line 1 of column 8 in the total on line 132 of Schedule 3, and include the amount from line 2 of column 8 in the total on line 153 of Schedule 3. 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