*** 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 T2101 E (09) ELECTION FOR GAINS ON SHARES OF A CORPORATION BECOMING PUBLIC - This form is for use by individuals to elect under section 48.1 of the Income Tax Act when their small business corporation ceases, immediately after that time, to be a small business corporation because its or another corporation's shares are listed on a designated stock exchange. - The intent of this election is to ensure that owners of qualified small business corporation shares do not lose their entitlement to the special capital gains deduction for gains accrued, but not realized, on their shares before the corporation ceases to be a small business corporation as indicated above. The special capital gains deduction amount increased to $750,000 from $500,000 effective March 19, 2007. By specifying any amount from the adjusted cost base up to the fair market value of the shares as proceeds of disposition, the owner can control the amount of taxable capital gain that will be brought into income for the elected disposition, and match that gain to the availability of the capital gains deduction. The shares are then considered as having been immediately reacquired at a capital cost equal to the elected proceeds of disposition. - The elected disposition does not apply for the purposes of sections 7 and 35, or paragraph 110(1)(d.1) of the Act. - File one completed copy of this election: -- on or before the individual's filing-due date for the individual's tax year in which the corporation ceases to be a small business corporation; -- at the tax centre where the individual's income tax return is normally filed; and -- separate from any tax return. (You may put it in the same envelope with a return, but do not insert it in or attach it to the return.) - Sections, subsections, and paragraphs mentioned on this form are from the Income Tax Act. Do not use this area Name of individual (print) ^ Social insurance number/trust account number (Enter 9-digit) ^ Address ^ Postal code ^ Area code ^ Telephone number ^ Filing-due date (Year/Month/Day) ^ Name of small business corporation (print) ^ Date corporation became public (Year/Month/Day) ^ Address ^ Business Number (Enter 9-digit) ^ Postal code ^ Proceeds of deemed disposition Line 1: Adjusted cost base (ACB) to the individual of shares of the corporation immediately before going public ^ Line 2: Fair market value (FMV) of shares of the corporation immediately before going public ^ Line 3: Specified proceeds of disposition where (2) exceeds (1) - (see notes) ^ Number of shares ^ Type of shares* ^ * If you need more space, attach a separate sheet. Notes: You may specify any amount from the ACB (1) to the FMV (2) as proceeds of disposition. The specified proceeds of disposition cannot be less than the ACB. Do not use this area Penalty for late-filed elections An election will be accepted up to 2 years following the individual's filing- due date for the individual's tax year in which the corporation ceases to be a small business corporation, provided a penalty is paid at the time of filing. Calculation of late-filed penalty per subsection 48.1(4): Line A: Amount (3) above ^ Line B: Less: amount (1) above ^ Line C: Difference ^ Multiplied by one quarter multiplied by 1% multiplied by N* ^ = ^ Line D: $100 multiplied by N* ^ Line E: Late-filing penalty is the lesser of C and D = ^ Amount enclosed** ^ * N is the total of each month and any part month (if applicable) during the period from the filing-due day to the actual date filed. ** Make cheque or money order payable to the Receiver General. Specify "T2101" on the remittance and indicate the tax year, the name, and social insurance number (or trust account number) of the taxpayer whose account is to be credited. Election and certification The above-named individual hereby elects to have the provisions of section 48.1 apply and hereby certifies that the information given in this election is true, correct and complete in every respect. Signature of individual or authorized person ^ Date (Year/Month/Day) ^