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MOODY NEW ADDRESS: 910, 736 - 8 Avenue SW
SHIKAZE Calgary, AB T2P 1H4
B OULET LLP Phone: 403-206-0840
CHARTERED ACCOUNTANTS Fax: 403-206-0841
2004 PERSONAL T AX RETURN ORGANIZER
Client: Date Completed:
We have designed this form to assist you in providing us with the basic data necessary to complete your personal tax return. Please check the appropriate column for each of the following questions to
indicate your replies. The column on the right shows the information we require to support your return for any item to which you reply "yes". Please attach the required information slips or other
information and place a tick beside the reference to it on this form or write in the information needed. Kindly note any questions which you may have.
Questions Yes No Information We Need
Identification
· Did you receive a Notice of Assessment for 2003? Please send a copy and any other correspondence you exchanged with Canada
Revenue Agency during the last year. If your 2003 return was not prepared by us,
please send a copy.
· Has any of the identification information shown on your personalized return now Please indicate below any changes from 2003. If you are not sending a personalized
changed? return and we did not complete your return for 2003, please answer all of these
questions:
Social Insurance Number:
Date of Birth:
Street Address:
City: Prov.: Postal Code:
Res. Phone: Bus. Phone:
Email: ___________________________________________________________
Province of Resi dence at December 31, 2004:
Citizenship (other than Canadian, if applicable):
Note, the definition of common-law includes two persons in a conjugal Marital Status: Single ____ Married ____ Divorced _____ Separated ______
relationship with such persons cohabiting for a period of 12 months or more. Living Common-law _____ Widowed _____
Spouse or Common-law Partner's Name:
Children's Names/Birthdates/Sex:
· Do you wish to be put on the Elections Canada voters list?
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Questions Yes No Information We Need
Sources of Income
· Employment income, commissions or profit sharing plan amounts received in 2004 2004 T4, T4PS and T4A slip for each employer
· Are you a participant in an employee or director stock option plan? Please provide details if any options were exercised or shares sold during the
year.
· Did you receive employment insurance benefits in 2004? 2004 T4U slips
· Did you receive pension income in 2004? 2004 T4A, T4A(OAS), T4A(P) slips
Total U.S. social security or other foreign country payments received in 2004.
· Did you receive interest or divi dends in 2004 from: 2004 T5, TBD2, T600, T3 slips or details of your foreign source income,
- Canadian Sources? (including Canadian Savings Bonds) including taxes withheld. A summary of the annual statement(s) from your
- Foreign Sources? broker(s) would be helpful, if available.
· Did you receive any partnership income? 2004 T5013 Supplementary slips
· Did you receive child support or spousal support payments in 2004? Details of amounts received and amounts paid to third parties on your behalf
(including a copy of your divorce/separation agreement unless previously
provided to us)
· Did you sell, gift or donate any property in 2004? The sale proceeds, cost of acquiring the property, cost s incurred in selling it,
Such as: stocks, bonds and other investments, your home or other real estate, personal portion of the proceeds or acquisition costs that are on account of income
property, art, stamps, coins, etc. accrued prior to the sale/purchase. If the property was owned on December
31, 1971, we need the V-Day value. A copy of the annual statement(s) from
your broker(s) would be helpful.
· Did you rent out property in 2004? Details of gross rental income and all related expenses. If your ownership of
the property is less than 100%, please indicate the percentage. Details of
the cost of land and buildings, unless previously provided to us.
· Were you self-employed in 2004? (i.e. farm income, professional income or other business Income statement or list of your receipts and expenses (including salaries
income)? paid to family members) together with a list of any purchases or sales of
capital assets including original cost and sale proceeds amounts.
· If self-employed, are you registered for GST? GST number:
· Did you receive any distributions from trusts in 2004? T3 slips or other details.
· Did you receive any other income not covered above? (i.e. foreign source income, tips, Details of income by source, with any supporting documents you have
available and details of any related expenses.
director's fees, training allowance, research grant, scholarships, bursaries, RRSP receipts,
pay equity payments)
Did you receive a loan from your employer during the year? Provide details of loans received.
· Have you sold shares of private corporations or farm property? Provide details of the original cost and proceeds of the sale.
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Questions Yes No Information We Need
Expenses and Deductions
· Did you contribute to an RRSP for 2004? Did you contribute stock to your RRSP? RRSP receipts. We also need details of any carryover from 2003 unless they have been
previously provided to us. If stock was contributed to your RRSP, please provide details.
· Did you participate in the RRSP Home Buyers Plan? Date and amount of the withdrawal. Amounts repaid prior to January 1, 2004 and
amounts included in your prior year's income. Please provide a copy of the 2004
Canada Revenue Agency Home Buyer Plan Statement of Account.
· Did you pay professional or union dues in 2004 that were not reimbursed by Receipt for amounts paid.
employer?
· Did you i ncur child care expenses in 2004? Amounts, with address and S.I.N. of person to whom paid (for each child).
· Did you move to a new residence at least 40 km closer to your new place of work Receipts and details of all moving expenses. Contact our office for a list of eligible
for which you were not reimbursed by your employer for expenses incurred? expenses.
· Did you pay child support or spousal support to a spouse/former spouse in 2004? Details, including a copy of your divorce/separation agreement (unless previously
provided to us), amounts paid directly and those paid to third parties on behalf of your
spouse. (Please differentiate between child support payments and/or spousal support.
We require cheque copies as proof of payment).
· Did you pay interest on money borrowed for investment purposes? Attach receipts or list details. Identify investment for which interest was incurred.
· Did you incur carrying charges in 2004? Attach a list of details. (exclude fees paid for RRSP)
(i.e. safety deposit box charges, accounting fees, investment counselling and
administration fee)
· Did you invest in any exploration and development activities for oil and gas or 2004 T101, T102 or T5013 slips for each investment
mining?
· Did you incur employment expenses for which you were not reimbursed by your A completed form T2200 signed by your employer, together with a calculation of the
employer? business and personal use of your car and a list of your expenses (including type of car).
· Did you purchase a tax shelter other than RRSP in 2004 or in a prior year? Details and supporti ng documents, including the tax shelter's financial statements for
2004 and its tax information. Attach T5013 and T -100 slips.
· Do you have a cumulative net investment loss account balance (only applicable We may need to confirm the amount of the balance with the CRA.
to the extent that you are planning to utilize all or a portion of the $500,000
capital gains deduction)?
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Questions Yes No Information We Need
Tax Credits
· Are you supporting another member of the family? Name, relationship, birthdate, if changed from last year, and income of each
dependant for the year.
· While attending a post -secondary school, did you have a student loan under the Name of post secondary school, a copy of the student loan statement that details
Canada Student Loans Act or some provincial statute? interest paid during 2004.
· Did you pay more than $99 for tuition in 2004 at a post -secondary level, either for Official receipts (Forms T2202 or T2202A). If there are receipts for dependants,
yourself or for a dependant? please forwa rd the net income of dependants together with the signed slip.
· Are you or a dependant eligible for a disability tax credit? Did you support a Please see us for Form T2201. If you supported a disabled dependant, please provide
disabled dependant? net income of the dependant.
· Did you incur any medical expenses (not reimbursed by an insurance company, Receipts for medical expenses (for both self and dependants) incurred in 2004, for
charitable donations or gifts to Canada or a Province or a provincial or federal donations (for which the receipt must include the registration number of the charity)
political party? and for gifts to the Crown.
· Did you receive any lump sum payments coveri ng more than one year? Provide details
· Did you make any personal income tax instalments during 2004? Provide receipts and amount paid.
Foreign Reporting – Separate return must be filed with CRA by April 30, 2005
· Did you own any assets located outside of Canada (at any time in 2004) such as If total cost is over $100,000, please provide details
foreign bank accounts, shares of Canadian companies held through a foreign
broker, shares in non-resident companies (even if held in a Canadian brokerage
account), foreign real estate (except for vacation property owned strictly for
personal use), and loans to a person not resident in Canada? Do not include
assets held in your RRSP
· Do you and related persons (including individuals, corporations) own 10% or more If total cost is over $100,000, please provide details
of the shares of a foreign affiliated company or trusts? Please include any shares
you hold indirectly, i.e. through a Canadian corporation.
· Have you ever transferred property or made a loan to a trust that is not resident in Provide details
Canada? (a trust will be considered to be non-resident if the majority of the
trustees are non-residents of Canada).
· Have you received a distribution or loan from a trust that is non-resident during Provide details
2004? Are you a beneficiary of a non-resident trust?
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Questions Yes No Information We Need
Automobile Claim
· Do you claim any automotive expense as a deduction on your employment, Please indicate below the automobile information:
business, professional and/or rental income in 2004? Vehicle Description:
Seating capacity:
Year: Make: Model:
Business kilometres during 2004:
Personal kilometres during 2004:
Total kilometre s during 2004: # days available for year:
Do you keep a kilometre log book (Y or N):
Is this vehicle registered under your corporation or your personal name:
Original cost (including PST and GST): $
Monthly lease payments: $
If new lease entered into during the year, since when
any lump sum lease payment
Operating costs paid personally:
Operating costs paid by corporation/employer:
Questions Yes No Information We Need
Additional Comments:
Would you be interested in discussing Personal Financial Planning Opportunities or
other tax and estate planning services provided by Moody Shikaze Boulet LLP?
Would you be interested in receiving an information/starter kit with respect to MSB's new
business advisory process for critical decision makers at closely held, successful private
firms called The Integrated Accounting ApproachTM? It will help you focus your
activities to attain greater financial freedom.
Client Signature