T1 GENERAL 2009 Income Tax and Benefit Return by lht10255

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									Name: Mary VINGTDEUX

SIN: 870-000-296

Canada Revenue Agence du revenu Agency du Canada

T1 GENERAL 2009 Income Tax and Benefit Return
1

Complete all the sections that apply to you in order to benefit from amounts to which you are entitled.

Identification
Print your name and address below. First name and initial Mary Last name VINGTDEUX Mailing address: Apt. No. – Street No. Street name 22 AV DES PINS P.O. Box R.R. City HALIFAX Prov./Terr. NS Postal code B3R 2K9

Information about you
Enter your social insurance number (SIN)if it is not on the label, or if you are not attaching a label: 870-000-296 Enter your date of birth(yyyy/mm/dd): 1970/07/08 Your language of correspondence: Votre langue de correspondance: English Français X

Tick the box that applies to your marital status on December 31, 2009:

(see the "Marital status" section in the guide for details) 1 X Married 2 Living common law 4
Divorced

3 6

Widowed Single

5

Separated

Information about your residence
Enter your province or territory of residence on December 31, 2009:

Information about your spouse or common-law partner (if you checked 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: 870-000-304
yyyy/mm/dd

Nova Scotia

Enter the province or territory where you currently reside if it is not the same as that shown above for your mailing address:

Enter his or her first name: DENIS Q Birthdate: 1970/02/28 Enter his or her net income for 2009 to claim certain credits: 1,450.00 Enter the amount of Universal Child Care Benefit included on line 117 of his or her return:

1,200.00

If you were self-employed in 2009, enter the province or territory of self-employment:

Enter the amount of Universal Child Care Benefit repayment included on line 213 of his or her return: Tick this box if he or she was self-employed in 2009: 1

0.00

If you became or ceased to be a resident of Canada in 2009, give the date of: mm/dd mm/dd entry departure or

Person deceased in 2009
If this return is for a deceased person, enter the date of death: Do not use this area
yyyy/mm/dd

Elections Canada
A) Are you a Canadian citizen?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes X 1 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? . . . . . . . . . . . . . Your authorization is valid until you file your next return. Your information will only be used for purposes Yes 1 No 2

No X 2

permitted under the Canada. Elections Act which includes 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
Are you applying for the GST/HST credit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................... Yes 1 No X 2

Do not use this area

172

171

Name: Mary VINGTDEUX

SIN: 870-000-296

2
Your guide contains valuable information to help you complete your return. When you come to a line on the return that applies to you, look up the line number in the guide for more information.

Please answer the following question
Did you own or hold foreign property at any time in 2009 with a total cost of more than CAN$100,000? (read the "Foreign income" section in the guide for details) . . . . . . . . . If yes, attach a completed Form T1135. 266 Yes 1 No X 2

If you had dealings with a non-resident trust or corporation in 2009, see the "Foreign income" section in the guide. As a Canadian resident, you have to report your income from all sources both inside and outside Canada.

Total income
Employment income (box 14 on all T4 slips) 102 Commissions included on line 101 (box 42 on all T4 slips) Other employment income Old Age Security pension (box 18 on the T4A(OAS) slip) CPP or QPP benefits (box 20 on the T4A(P) slip) Disability benefits included on line 114 152 (box 16 on the T4A(P) slip) Other pensions or superannuation Elected split-pension amount (see the guide and attach Form T1032) Universal Child Care Benefit (see the guide) Employment Insurance and other benefits (box 14 on the T4E slip) Taxable amount of dividends (eligible and other than eligible) from taxable Canadian corporations (see the guide and attach Schedule 4) Taxable amount of dividends other than eligible dividends, 180 included on line 120, from taxable Canadian corporations Interest and other investment income (attach Schedule 4) Net partnership income: limited or non-active partners only (attach Schedule 4) Registered disability savings plan income (see the guide) Rental income Gross 160 Taxable capital gains (attach Schedule 3) Support payments received Total 156 RRSP income (from all T4RSP slips) Other income Specify: Self-employment income (see lines 135 to 143 in the guide) Business income Gross 162 Professional income Gross 164 Commission income Gross 166 Farming income Gross 168 Fishing income Gross 170 Workers' compensation benefits (box 10 on the T5007 slip) Social assistance payments Net federal supplements (box 21 on the T4A(OAS) slip) Add lines 144, 145, and 146 (see line 250 in the guide) 0.00 Net 0.00 104 + 113 + 114 + 0.00 115 116 117 119 + + + + 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 101 35,480.00

120 + 0.00 121 + 122 + 125 + 126 + 127 +

4,020.00 0.00 0.00 0.00 2,500.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00

Taxable amount 128 + 129 + 130 + Net Net Net Net Net 144 145 + 146 + 0.00 0.00 0.00 135 137 139 141 143 + + + + +

0.00 0.00 0.00 0.00 0.00

= 0.00 => 147 + Add lines 101, 104 to 143, and 147 This is your total income. 150 =

0.00 42,000.00

Name: Mary VINGTDEUX

SIN: 870-000-296

3
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
Enter your total income from line 150 Pension adjustment (box 52 on all T4 slips and box 34 on all T4A slips) 150 42,000.00

206

0.00 0.00 500.00

Registered pension plan deduction (box 20 on all T4 slips and box 32 on all T4A slips) 207 RRSP deduction (see Schedule 7 and attach receipts) 208 + Saskatchewan Pension Plan deduction (maximum $600) 209 + Deduction for elected split-pension amount (see guide and attach Form T1032) Annual union, professional, or like dues (box 44 on all T4 slips and receipts) Universal Child Care Benefit repayment (box 12 on all RC62 slips) Child care expenses (attach Form T778) Disability supports deduction Business investment loss Moving expenses Gross 228 210 + 212 + 213 + 214 + 215 + Allowable deduction 217 + 219 +

0.00 0.00 0.00 0.00 0.00

0.00

Support payments made Total 230 Allowable deduction 220 + Carrying charges and interest expenses (attach Schedule 4) 221 + 0.00 Deduction for CPP or QPP contributions on self-employment and other earnings 222 + 0.00 (attach Schedule 8) Exploration and development expenses (attach Form T1229) 224 + 0.00 Other employment expenses 229 + 0.00 231 + 0.00 Clergy residence deduction 232 + 0.00 Other deductions Specify: 500.00 => – Add lines 207 to 224, 229, 231, and 232. 233 = Line 150 minus line 233 (if negative, enter "0"). This is your net income before adjustments. 234 = 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. 235 –
Line 234 minus line 235 (if negative, enter "0"). If you have a spouse or common-law partner, see line 236 in the guide.

500.00 41,500.00 0.00 41,500.00

This is your net income. 236 =

Taxable income
Canadian Forces personnel and police deduction (box 43 on all T4 slips) 244 0.00 Employee home relocation loan deduction (box 37 on all T4 slips) 248 + 0.00 Security options deductions 249 + 0.00 Other payments deduction (if you reported income on line 147, see line 250 in the guide) 250 + 0.00 Limited partnership losses of other years 251 + 0.00 Non-capital losses of other years 252 + 0.00 Net capital losses of other years 253 + Capital gains deduction 254 + 0.00 Northern residents deductions (attach Form T2222) 255 + 0.00 256 + 0.00 Additional deductions Specify: 0.00 => – Add lines 244 to 256. 257 = Line 236 minus line 257 (if negative, enter "0") This is your taxable income. 260 =

0.00 41,500.00

Use your taxable income to calculate your federal tax on Schedule 1 and your provincial or territorial tax on Form 428.

Name: Mary VINGTDEUX

SIN: 870-000-296

4
Refund or Balance owing
Net federal tax: enter the amount from line 55 of Schedule 1 (attach Schedule 1, even if the result is "0") CPP contributions payable on self-employment and other earnings (attach Schedule 8) Social benefits repayment (enter the amount from line 235) 420 421 + 422 + 428 + Add lines 420 to 428 0.00 0.00 0.00 1,415.67 1,415.67

Provincial or territorial tax

(attach Form 428, even if the result is "0")

This is your total payable 435 =
Total income tax deducted (see the guide) Refundable Quebec abatement CPP overpayment (enter your excess contributions) Employment Insurance overpayment (enter your excess contributions) Refundable medical expense supplement (use federal worksheet) Working Income Tax Benefit (WITB) (attach Schedule 6) Refund of investment tax credit (attach Form T2038(IND)) Part XII.2 trust tax credit (box 38 on all T3 slips) Employee and partner GST/HST rebate (attach Form GST370) Tax paid by instalments 437 440 448 450 452 453 454 456 3,328.00 + + + + + + + 0.00 0.00 173.65 0.00 0.00 0.00 0.00

457 + 476 + 479 + Add lines 437 to 479

Provincial or territorial credits

(attach Form 479 if it applies)

0.00 3,501.65 => – = 3,501.65 -2,085.98

These are your total credits. 482 =

Line 435 minus line 482

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.

Refund 484

2,085.98

Balance owing

(see line 485 in the guide)

485

0.00

Direct deposit - Start or change
You do not have to complete this area every year. year if your direct deposit information has not changed. Do not complete it this

Amount enclosed 486
Attach to page 1 a cheque or money order payable to the Receiver General. Your payment is due no later than April 30, 2010.

Refund, GST/HST credit and WITB advance payments , and any other deemed overpayment of tax

-To start direct deposit or to change account information only, attach a "void" cheque or complete lines 460, 461, and 462. Note: 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. Branch Institution number number Account number CCTB UCCB 462 463 491 460 461
(5digits) (3digits) (maximum 12 digits)

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 (902)642-2212 Date

490 For professional tax preparers only

Name: Address:

Telephone:

Do not use this area

487

488

RC-09-111

Name: Mary VINGTDEUX

SIN: 870-000-296

T1-2009
income, and Step 3 to calculate your net federal tax.

Federal Tax

Schedule 1

Complete Step 1 to claim your federal non-refundable tax credits, Step 2 to calculate your federal tax on taxable

You must attach a copy of this schedule to your return.

Step 1 – Federal non-refundable tax credits
Basic personal amount claim $10,320 300 301 + 303 + 305 + 367 + 306 + 308 310 312 363 364 365 368 369 313 314 315 316 318 319 323 324 326 + + + + + + + + + + + + + + + + + 10,320.00 1 0.00 2 8,870.00 3 0.00 4 10,445.00 5 0.00 6 1,583.01 0.00 613.80 1,044.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 7 8 9 10 11 12 13 14 15 16 17 18

Age amount (if you were born in 1944 or earlier) (maximum $6,408) X Spouse or common-law partner amount(if negative, enter "0") $10,320 minus 1,450.00 his or her net income from pg. 1 of your return) = Amount for an eligible dependant (attach Schedule 5) (if negative, enter "0") $10,320 minus 0.00 his or her net income = Amount for children born in 1992 or later Number of children 366 5 x $2,089 = Amount for infirm dependants age 18 or older (use federal worksheet and attach Schedule 5) CPP or QPP contributions: through employment from box 16 and box 17 on all T4 slips (maximum $2,118.60) on self-employment and other earnings (attach Schedule 8) Employment Insurance premiums from box 18 and box 55 on all T4 slips (maximum $731.79) Canada employment amount (maximum $1044) Public transit amount X Children's fitness amount Home renovation expenses (see line 368 in the guide and attach Schedule 12) Home buyers' amount (see line 369 in the guide) Adoption expenses Pension income amount (use federal worksheet) (maximum $2,000.00) Caregiver amount (use federal worksheet and attach Schedule 5) Disability amount (for self) (claim $7,196 or if you were under age 18, use federal worksheet) Disability amount transferred from a dependant (use federal worksheet) Interest paid on your student loans Tuition, education, and textbook amounts (attach Schedule 11) Tuition, education, and textbook amounts transferred from a child Amounts transferred from your spouse or common-law partner (attach Schedule 2) Medical expenses for self, spouse or common-law partner, and your dependent children born in 1992 or later 330 0.00 1,245.00 Minus: $2,011 or 3% of line 236, whichever is less – Subtotal (if negative, enter "0") 0.00 (A) = Allowable amount of medical expenses for other dependants 4,500.00 (B) (see the calculation at line 331 in the guide and attach Schedule 5) 331 + Add lines (A) and (B). 4,500.00 => = Add lines 1 to 24.

0.00 19 20 8,986.06 21 0.00 22 0.00 23

332 + 335 =

4,500.00 24 46,361.87 25 6,954.28 26 0.00 27 6,954.28 28

Donations and gifts (attach Schedule 9)

Multiply the amount on line 25 by 15% . 338 = 349 + add lines 26 and 27. 350 =

Total federal non-refundable tax credits:

Name: Mary VINGTDEUX

SIN: 870-000-296

Step 2 – Federal tax on taxable income
Enter your taxable income from line 260 of your return If line 29 is more than $40,726 but not more than $81,452 41,500.00 – 40,726.00 774.00 = 22% x 170.28 = + 6,109.00 = 6,279.28 41,500.00 29 If line 29 is more than $81,452 but not more than $126,264 0.00 – 81,452.00 0.00 = x 26% 0.00 = + 15,069.00 = 0.00

Use the amount on line 29 to determine which ONE of the following columns you have to complete. Enter the amount from line 29. Base amount Line 30 minus line 31 (cannot be negative) Rate Multiply line 32 by line 33. Tax on base amount Add lines 34 and 35

If line 29 is $40,726 or less 0.00 0.00 0.00 = x 15% 0.00 = 0.00 = 0.00

– = x = + =

If line 29 is more than $126,264 0.00 126,264.00 0.00 29% 0.00 26,720.00

30 31 32 33 34 35

0.00 36

Step 3 – Net federal tax
Enter the amount from line 36 above Federal tax on split income (from line 5 of Form T1206) 424 + Add lines 37 and 38 404 = 350 425 + 426 + 427 + Add lines 40 to 43. = 6,279.28 37 0.00 38 6,279.28 => 6,954.28 0.00 0.00 0.00 6,954.28 40 41 42 43 => –

6,279.28 39

Enter your non-refundable tax credits from line 28 Federal dividend tax credit (see line 425 in the guide) Overseas employment tax credit (attach Form T626) Minimum tax carry-over (attach Form T691)

6,954.28 44 0.00 45

Basic federal tax:

Line 39 minus line 44 (if negative, enter "0") 429 =

Federal foreign tax credit (attach Form T2209) Federal tax: Total federal political contributions (attach receipts) Federal political contribution tax credit (use federal worksheet) Investment tax credit (attach Form T2038(IND)) Labour-sponsored funds tax credit Net cost 413

405 – Line 45 minus line 46 (if negative, enter "0") 406 = 409 410 412 + 0.00 0.00 51 52 53 => – 417 = 415 + 418 + 420 =

0.00 46 0.00 47

Allowable credit 414 + 0.00 Add lines 51 to 53. 416 = 0.00 Line 47 minus line 54 (if negative, enter "0") (if you have an amount on line 38 above, see Form T1206) Working Income Tax Benefit (WITB) advance payments received (box 10 on the RC210 slip). Additional tax on RESP accumulated income payments (attach Form T1172) Net federal tax: Add lines 55 and 57 Enter this amount on line 420 of your return.

0.00 54 0.00 55 0.00 56 0.00 57 0.00 58

RC-09-111

Name: Mary VINGTDEUX

SIN: 870-000-296

Nova Scotia Tax and Credits
Complete this form and attach a copy of it to your return. For details, see the forms book.

NS428
T1 General - 2009

Step 1 - Nova Scotia non-refundable tax credits
For internal use only 5602 claim $7,981 5804 7,981.00 Basic personal amount (maximum $3,897) 5808 + 0.00 Age amount (if born in 1944 or earlier) (use provincial worksheet) Spouse or common-law partner amount: 7,456.00 Base amount Minus: his or her net income 1,450.00 from page 1 of your return – 6,006.00 (maximum $6,778)=> 5812 + 6,006.00 Result: (if negative, enter "0") = (use provincial worksheet) 5816 + 0.00 Amount for an eligible dependant (use provincial worksheet) 5820 + 0.00 Amount for infirm dependants age 18 or older (see line 5823 in the forms book) Amount for young children 5823 + 0.00 Number of months 6372 0 x $100 = (Complete the chart on the last page) Canada Pension Plan or Quebec Pension Plan contributions: 1,583.01 (amount from line 308 of your federal Schedule 1) 5824 + 0.00 (amount from line 310 of your federal Schedule 1) 5828 + 613.80 (amount from line 312 of your federal Schedule 1) 5832 + Employment Insurance premiums 0.00 Pension income amount (maximum $1,104) (see line 5836 in the forms book) 5836 + 0.00 Caregiver amount (use provincial worksheet) 5840 + 0.00 (see line 5844 in the forms book) 5844 + Disability amount (for self) 0.00 (use provincial worksheet) 5848 + Disability amount transferred from a dependant 1,200.00 (see line 5849 in the forms book) 5849 + Sport and recreational expenses for children 0.00 (amount from line 319 of your federal Schedule 1) 5852 + Interest paid on your student loans (attach Schedule NS(S11) 5856 + 10,720.00 Your tuition and education amounts 5860 + 0.00 Tuition and education amounts transferred from a child (attach Sch. NS(S2) 5864 + 0.00 Amounts transferred from your spouse or common-law partner 5868 0.00 19 Medical expenses from line 330 of your federal Schedule 1 Enter $1,637 or 3% of net income from line 236 of your return, whichever is less – 1,245.00 20 Line 19 minus line 20 (if negative, enter "0") 0.00 21 = Allowable amount of medical expenses for other dependants 5872 + 4,500.00 22 calculated for line 5872 on the Provincial Worksheet 5876 = 4,500.00 => + Add lines 21 and 22 4,500.00 5880 = 32,603.81 Add lines 1 through 18, and line 23 Non-refundable tax credit rate Multiply line 24 by line 25 Donations and gifts : Amount from line 345 of your federal Schedule 9 0.00 x 8.79%= 0.00 Amount from line 347 of your federal Schedule 9 0.00 x 17.50%= + 0.00 5896 = 0.00 Add lines 27 and 28 Add lines 26 and 29 Nova Scotia non-refundable tax credits Enter this amount on line 42

1 2

3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

23 => x 5884 = 27 28 =>

32,603.81 24 8.79% 25 2,865.87 26

+

0.00 29 2,865.87 30

6150 =

Name: Mary VINGTDEUX

SIN: 870-000-296

Step 2 – Nova Scotia tax on taxable income
Enter your taxable income from line 260 of your return Use the amount on line 31 to determine which ONE of the following columns you have to complete. Enter the amount from line 31 in the applicable column Line 32 minus line 33 (cannot be negative) Multiply line 34 by line 55 Nova Scotia tax on taxable income – = x = + 41,500.00 31

If line 31 is $29,590 or less

If line 31 is more than $29,590,but not more than $59,180

If line 31 is more than $59,180, but not more than $93,000

If line 31 is more than $93,000

0.00 0.00 0.00 8.79% 0.00 0.00

– = x = + =

41,500.00 29,590.00 11,910.00 14.95% 1,780.55 2,601.00 4,381.55 Go to Step 3

– = x = + =

0.00 59,180.00 0.00 16.67% 0.00 7,025.00 0.00 Go to Step 3

– = x = + =

0.00 93,000.00 0.00 17.50% 0.00 12,662.00 0.00 Go to Step 3

32 33 34 35 36 37 38

Add lines 36 and 37

0.00 = Go to Step 3

Step 3 – Nova Scotia tax
Enter your Nova Scotia tax on taxable income from line 38 above Enter your Nova Scotia tax on split income, if applicable, from Form T1206 Add lines 39 and 40 Enter your Nova Scotia non-refundable tax credits from line 30 Nova Scotia dividend tax credit: Credit calculated for line 6152 on the Provincial Worksheet Nova Scotia overseas employment tax credit: Amount from line 426 on federal Schedule 1 0.00 Nova Scotia minimum tax carry-over Amount from line 427 of federal Schedule 1 0.00 Add lines 42 through 45 Line 41 minus line 46 (if negative, enter "0") Nova Scotia additional tax for minimum tax purposes: Amount from line 117 of Form T691 0.00 Add lines 47 and 48 Nova Scotia surtax: (Amount from line 49 1,515.67 minus $10,000) Add lines 49 and 50 Enter the provincial foreign tax credit from Form T2036 Line 51 minus line 52 6151 + = 2,865.87 42 6152 + x 57.5% = 6153 + x 57.5% = 6154 + = 0.00 43 0.00 44 0.00 45 2,865.87 => – = + = + = – = 4,381.55 39 0.00 40 4,381.55 41

2,865.87 46 1,515.67 47 0.00 48 1,515.67 49 0.00 1,515.67 0.00 1,515.67 50 51 52 53

x 57.5% =

x

10% (if negative, enter "0")

Nova Scotia low-income tax reduction
If you had a spouse or common-law partner on December 31, 2009, you have to agree on who will claim the tax only one you can make this claim for for your family. reduction as only one ofof you can make this claim your family.

Adjusted family income for the calculation of the Nova Scotia low-income tax reduction

Column 1 You

Enter the net income amount from line 236 of the return Total of the Universal Child Care Benefit repayment (line 213 of the return) and the registered disability savings plan income repayment (included on line 232) Add lines 54 and 55 Total of the Universal Child Care Benefit income (line 117 of the return) and income from a registered disability savings plan (included on line 125) Line 56 minus line 57 (if negative, enter "0") Add the amounts from line 58 in column 1 and column 2, if applicable Enter the amount on line 66 on the next page

41,500.00 54 + = – = 0.00 55 + 41,500.00 56 = 0.00 57 – 41,500.00 58 =

Column 2 Your spouse or common-law partner 1,200.00 54 0.00 1,200.00 1,200.00 0.00 41,500.00 55 56 57 58 59

Adjusted family income

Continue on the next page ==>

Name: Mary VINGTDEUX

SIN: 870-000-296

Step 3 – Nova Scotia tax
X Claim Nova Scotia low-income tax reduction Enter the amount from Line 53 on the previous page
Check if you were confined in prision or similar institution for more than 6 months.

1515.67 300.00 61 300.00 62

60

Basic reduction claim $300 6195 Reduction for spouse or common-law partner claim $300 6197 + Check if spouse or common-law partner was confined in prision or similar institution for more than 6 months. Reduction for an eligible dependant claimed on line 5816 claim $300 6199 + (see line 63 in the forms book) Reduction for dependent children born in 1991 or later Number of dependent children 6099 5x $165 = + = Add lines 61 through 64

0.00 63 825.00 64 1,425.00 65

Adjusted family income
Enter the amount from line 59 on the previous page Base amount Line 66 minus line 67 (if negative, enter "0") Applicable rate Multiply line 68 by line 69 Line 65 minus line 70, (if negative, enter "0") Line 60 minus line 71 (if negative enter "0") 41,500.00 15,000.00 26,500.00 5% 1,325.00 66 67 68 69 =>

– = x =

– =

1,325.00 70 100.00 => – = 100.00 71 1,415.67 72

Nova Scotia low-income tax reduction

Political contribution tax credit
Nova Scotia political contributions made in 2009 Line 72 minus line 73 (if negative, enter "0") 6210 x 75% = (max $750) – = 0.00 73 1415.67 74

Labour-sponsored venture capital tax credit
Cost of shares from Form NSLSV Line 74 minus line 75 (if negative, enter "0") x 20% = (max $2,000) 6238 – = 0.00 75 1415.67 76

Post-secondary graduate tax credit
Unused post-secondary graduate tax credit from your 2008 notice of assessment or notice of reassessment Line 76 minus line 77 (if negative, enter "0") (see line 77 in the forms book) – = 77 78

1415.67

Graduate retention rebate
Claim this rebate if you graduated from a university or college program in 2009. 6378 If you graduated from an institution outside Nova Scotia, check this box. or enter $1,250 for a college program. Enter $2,500 for a university program Line 78 minus line 79 (if negative, enter "0")
(see line 79 in the forms book) 6379 –

=

0.00 79 1,415.67 80

Equity tax credit
Enter the equity tax credit calculated on Form T1285 Line 80 minus line 81 (if negative, enter "0") Enter the result on line 428 of your return – Nova Scotia tax = 0.00 81 1415.67 82

Nova Scotia volunteer firefighters and ground search and rescue tax credit
Volunteer firefighters and ground search and rescue tax credit (see line 83 in the forms book) Enter this amount on line 479 of your return claim $500 6228 0.00 83

Details of amount for young children
Child's name 1 VINGTDEUX 2 VINGTDEUX 3 VINGTDEUX 4 VINGTDEUX 5 VINGTDEUX 6 VINGTDEUX

(if you need more space, attach a separate sheet of paper) Child's date of birth yyyy/mm/dd 1998/07/15 1996/09/20 1994/01/15 2006/08/08 2000/04/15 1986/07/08 Number of eligible months 0 0 0 0 0 0 0 0 0

Relationship to you Son Son Son Son Son Son

Total number of eligible months for all children

+ + + + + + + Enter this amount beside box 6372 on the first page =

RC-09-111

Name: Mary VINGTDEUX

SIN: 870-000-296

T1-2009

Details of Dependant

Schedule 5

See the guide to find out if you can claim an amount on lines 305, 306, 315, and/or 331 of Schedule 1. To calculate the amount you claim on line 306 or 315, complete the applicable chart on the federal worksheet, which you will find in the forms book. To calculate the amount for line 331, read the instructions for line 331 in the guide. For each dependant claimed on lines 305, 306, 315, and/or 331, provide the details requested below. Attach a copy of this schedule to your return.

Line 305 - Amount for an eligible dependant
If your marital status changed in 2009, give the date of the change (mm/dd) (Do not forget to check the box on page 1 of your return to indicate your marital status.) Last name First name Address Date of birth Relationship (yyyy/mm/dd) to you Net income in 2009 0.00 Enter line 305 Nature of the infirmity (if it applies) Amount of claim

0.00 0.00

Lines 306, 315, and/or 331
1. Last name VINGTDEUX First name 1 Address 22 AV DES PINS HALIFAX NSB3R 2K9 2. Last name VINGTDEUX First name 2 Address 22 AV DES PINS HALIFAX NSB3R 2K9 3. Last name VINGTDEUX First name 3 Address 22 AV DES PINS HALIFAX NSB3R 2K9 4. Last name VINGTDEUX First name 4 Address 22 AV DES PINS HALIFAX NSB3R 2K9 5. Last name VINGTDEUX First name 5 Address 22 AV DES PINS HALIFAX NSB3R 2K9 6. Last name VINGTDEUX First name 6 Address 22 AV DES PINS HALIFAX NSB3R 2K9 7. Last name First name Address Date of birth Relationship (yyyy/mm/dd) to you 1998/07/15 Son Net income in 2009 0.00 Net income in 2009 0.00 Net income in 2009 0.00 Net income in 2009 0.00 Net income in 2009 0.00 Net income in 2009 0.00 Net income in 2009 Nature of the infirmity (if it applies) Nature of the infirmity (if it applies) Nature of the infirmity (if it applies) Nature of the infirmity (if it applies) Nature of the infirmity (if it applies) Nature of the infirmity (if it applies) Nature of the infirmity (if it applies) Line claimed 306 315 331 Line claimed 306 315 331 Line claimed 306 315 331 Line claimed 306 315 331 Line claimed 306 315 331 Line claimed 306 315 331 Line claimed Amount of claim 0.00 0.00 0.00 Amount of claim 0.00 0.00 0.00 Amount of claim 0.00 0.00 0.00 Amount of claim 0.00 0.00 0.00 Amount of claim 0.00 0.00 0.00 Amount of claim 0.00 0.00 4,500.00 Amount of claim 0.00 0.00 0.00 Amount of claim 0.00 0.00 0.00 Amount of claim 0.00 0.00 0.00 Amount of claim 0.00 0.00 0.00 Amount of claim 0.00 0.00 0.00 Amount of claim 0.00 0.00 0.00

Date of birth Relationship (yyyy/mm/dd) to you 1996/09/20 Son

Date of birth Relationship (yyyy/mm/dd) to you 1994/01/15 Son

Date of birth Relationship (yyyy/mm/dd) to you 2006/08/08 Son

Date of birth Relationship (yyyy/mm/dd) to you 2000/04/15 Son

Date of birth Relationship (yyyy/mm/dd) to you 1986/07/08 Son

Date of birth Relationship (yyyy/mm/dd) to you

8. Last name First name Address

Date of birth Relationship (yyyy/mm/dd) to you

Net income in 2009

Nature of the infirmity (if it applies)

Line claimed

9. Last name First name Address

Date of birth Relationship (yyyy/mm/dd) to you

Net income in 2009

Nature of the infirmity (if it applies)

Line claimed

10. Last name First name Address

Date of birth Relationship (yyyy/mm/dd) to you

Net income in 2009

Nature of the infirmity (if it applies)

Line claimed

11. Last name First name Address

Date of birth Relationship (yyyy/mm/dd) to you

Net income in 2009

Nature of the infirmity (if it applies)

Line claimed

12. Last name First name Address

Date of birth Relationship (yyyy/mm/dd) to you

Net income in 2009

Nature of the infirmity (if it applies)

Line claimed

RC-09-111

Name: Mary VINGTDEUX

SIN: 870-000-296

EMPLOYEE OVERPAYMENT OF 2009 CANADA PENSION PLAN CONTRIBUTIONS AND 2009 EMPLOYMENT INSURANCE PREMIUMS
Complete Section A in Part 1 to determine any overpayment of Canada Pension Plan (CPP) or Quebec Pension Plan (QPP) contributions made through employment if you had no self-employment earnings and you were not a resident of Quebec on December 31, 2009. If however, you worked in Quebec, or you worked in Quebec and in a province other than Quebec in 2009, and you were either 70 years of age or older, or you received a CPP or QPP retirement pension, complete Section B in Part 1. Do not complete Section A in Part 1. Note: If the individual died in 2009, complete Section A in Part 1.

Do not complete this form if you were a resident of Quebec on December 31, 2009, and you made CPP or QPP contributions. See line 452 in your Quebec provincial income tax guide. Complete Part 2 on the next page to determine any overpayment of Employment Insurance (EI) premiums.

Part 1 - Calculating your Canada Pension Plan overpayment
Section A -- Read the above instructions to determine if you should complete this section.

If any of the following situations apply to you, read the instructions below and if applicable, use the table to determine the maximum amounts for lines 1, 2, 3, and 5: If throughout 2009, you were over 70 years of age or you received CPP or QPP retirement benefits, enter "0" at line 1. If you turned 18 in 2009, use the number of months in the year after the month you turned 18 years of age. If you turned 70 in 2009, use the number of months in the year up to and including the month you turned 70 years of age. If you received, or were entitled to receive a CPPor QPP retirement pension, or a CPP or QPP disability pension for part of 2009, use the number of months in the year you did not or were not entitled to receive the pension. • If the individual died in 2009, use the number of months in the year up to and including the month the individual died Total CPP/QPP pensionable earnings (box 26 or, if blank, box 14 of your T4 slips) . . . . (maximum $46,300) 35,480.00 Contributory earnings from self-employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . + 0.00 Basic CPP/QPP exemption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (maximum $ 3,500) – 3,500.00 Earnings subject to contribution (if negative, enter "0") . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(maximum $42,800) .. = 31,980.00 Total CPP / QPP contributions deducted (from boxes 16 of your T4 slips) . . . . . . . . . . . . . . . . . . . . . Required contribution: Multiply line 3 by 4.95% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (maximum $2,118.6) Line 4 minus line 5 (if negative, enter "0") . . . . . . . . . . . . . . . . . . Canada Pension Plan overpayment
If the amount from line 6 is positive, enter it on line 448 of your return. If negative, you can choose to make additional CPP

• • • •

1 2 3 4 5 6

– =

1,583.01 1,583.01 0.00

contributions. See "Making additional CPP contributions" on page 34 of the General Income Tax and Benefit Guide. Enter the amount from line 4 or 5, whichever is less, on line 308 of Schedule 1 and, if it applies, on line 5824 of Form 428.

Monthly proration table for 2009
Applicable number of months Line 1 or Line 7 Maximum amount of total CPP/QPP pensionable earnings Line 2 Maximum amount of basic CPP/QPP exemption Line 3 Maximum amount of earnings subject to contribution Line 5 Maximum amount of required contribution

1 2 3 4 5 6 7 8 9 10 11 12 Section B

$3,858.33 $7,716.66 $11,575.00 $15,433.33 $19,291.66 $23,150.00 $27,008.33 $30,866.66 $34,725.00 $38,583.33 $42,441.66 $46,300.00

$291.66 $583.33 $875.00 $1,166.66 $1,458.33 $1,750.00 $2,041.66 $2,333.33 $2,625.00 $2,916.66 $3,208.33 $3,500.00

$3,566.67 $7,133.33 $10,700.00 $14,266.67 $17,833.33 $21,400.00 $24,966.67 $28,533.33 $32,100.00 $35,666.67 $39,233.33 $42,800.00

$176.55 $353.10 $529.65 $706.20 $882.75 $1,059.30 $1,235.85 $1,412.40 $1,765.50 $1,942.05 $1,588.95 $2,118.60

-- Complete this section only if you worked in Quebec, or you worked in Quebec and in a province other than Quebec in 2009, and you were either 70 years of age or older, or you received a CPP or QPP retirement pension.

If any of the following situations apply to you, determine the amount to enter at line 7 as follows:

• If throughout 2009, you were over 70 years of age or you received CPP or QPP retirement benefits, enter "0" at line 7. • If you turned 70 years of age in 2009, use the above table to determine the maximum amount for line 7 by using the number of months in the year up to and including the month you turned 70 years of age. • If you received, or were entitled to receive a CPP or QPP retirement pension, or a CPP or QPP disability pension for part of 2009, use the above table to determine the maximum amount for line 7 by using the number of months in the year you did not or were not entitled to receive the pension. Total CPP pensionable earnings (box 26 or, if blank, box 14 of your T4 slips where the province of employment is not Québec) or the maximum amount as per above instructions, whichever is less. Contributory earnings from self-employment Total QPP pensionable earnings (box 26 or, if blank, box 14 of your T4 slips where the province of employment is Québec) Add lines 7 and 8. Total CPP/QPP pensionable earnings Basic CPP/QPP exemption Earnings subject to contribution (if negative, enter "0")

CPP pensionable earnings + QPP pensionable earnings (maximum $ 46,300) + = – =

0.00 0.00 0.00 0.00

7

8 9

(maximum $ 42,800)

3,500.00 10 0.00 11 0.00 12 0.00 13 0.00 14

Total CPP and QPP contributions deducted (from boxes 16 and 17 of your T4 slips) Required contribution: multiply line 11 by 4.95% (maximum $2,118.60) – Line 12 minus line 13 (if negative, enter "0") Canada Pension Plan overpayment = If the amount from line 14 is positive, enter it on line 448 of your return. Enter the amount from line 12 or 13, whichever is less, on line 308 of Schedule 1 and, if it applies, on line 5824 of Form 428.

Complete Part 2 to determine any overpayment of Employment Insurance (EI) premiums. To be refunded, the amount of the EI overpayment has to be more than $1. Do not complete Part 2 if you were a resident of Quebec on December 31, 2009, and you have to complete Schedule 10.

Part 2 - Calculating your Employment Insurance overpayment
Total EI insurable earnings (box 24 or, if blank, box 14 of your T4 slips) (maximum $42,300. If $2,000 or less, enter "0") Total premiums deducted: Residents of other than Quebec (from box 18 and box 55 of all your T4 slips) Quebec residents (from box 18 of all your T4 slips) Line 1 minus $2,000 (if negative, enter "0") Line 2 minus line 3 (if negative, enter "0") Total premiums deducted: Residents of other than Quebec (from box 18 and box 55 of all your T4 slips) Quebec residents (from box 18 of all your T4 slips) Required premium: Residents of other than Quebec (multiply line 1 by 1.73%) (maximum $731.79) Quebec residents (multiply line 1 by 1.38%) (maximum $583.74) Line 5 minus line 6 (if negative, enter "0") 35,480.00 613.80 33,480.00 0.00 1 2 3 4

– =

613.80 – = 613.80 0.00 0.00

5 6 7 8

Enter the amount from line 4 or line 7, whichever is greater . . .Employment Insurance overpayment Enter the amount from line 8 on line 450 of your return only if it is more than $1. Enter the amount from line 3, 5, or 6, whichever is least, on line 312 of Schedule 1 and, if it applies, on line 5832 of Form 428.

RC-09-111

Name: Mary VINGTDEUX

SIN: 870-000-296

Provincial Tuition and Education Amounts
Only the student must complete this schedule. Use it to: - calculate your Nova Scotia tuition and education amounts to claim on line 5856 of your Form NS428; - determine the provincial amount available to transfer to another designated individual; and - determine the unused provincial amount, if any, available for you to carry forward to a future year. Only the student attaches a copy of this schedule to his or her return.

Schedule NS(S11)
T1 General - 2009

Nova Scotia tuition and education amounts claimed by the student for 2009
Nova Scotia unused tuition and education amounts from your 2008 notice of assessment or notice of reassessment * 5914 Enter your eligible tuition fees paid for 2009 10,000.00 Education amount for 2009: Use columns B and C of forms T2202, T2202A, TL11A, TL11B, and TL11C; only one claim per month, (maximum 12 months) Enter the number of months from Column B 5916 + (do not include any month that is also included in Column C) 12 x $60 = 720.00 5918 + Enter the number of months from Column C 0 x $200 = 0.00 Add lines 2 to 4 Total 2009 tuition and education amounts = 10,720.00 Add lines 1 and 5 Total available tuition and education amounts Taxable income from line 260 of your return Total of lines 5804 to 5849 of your Form NS428 Line 7 minus line 8 (if negative, enter "0") Unused Nova Scotia tuition and education amounts claimed for 2009: Enter the amount from line 1 or line 9, whichever is less Line 9 minus line 10 2009 tuition and education amounts claimed for 2009: Enter the amount from line 5 or line 11, whichever is less Add lines 10 and 12. Enter this amount on line 5856 of your Form NS428. 2 0.00 1

3 4 =>

+ =

10,720.00 5 10,720.00 6

– = – =

49,846.93 7 17,383.81 8 32,463.12 9 0.00 => 32,463.12 11 0.00 10

+ Nova Scotia tuition and education amounts claimed by the student for 2009 =

10,720.00 12 10,720.00 13

Transfer / Carry forward of unused amount
Amount from line 6 Amount from line 13 Line 14 minus line 15 If you are transferring an amount to another individual, continue on line 17. Otherwise, enter the amount from line 16 on line 21. Enter the amount from line 5; if it is more than $5,000 enter $5,000 Amount from line 12 Line 17 minus line 18 (if negative, enter "0") 5,000.00 17 10,720.00 18 0.00 19 – = 10,720.00 14 10,720.00 15 0.00 16

Total unused amount

Maximum transferable

– =

You can transfer all or part of the amount on line 19 to your spouse or common-law partner, to his or her parent or grandparent, or to your parent or grandparent. To do this, you have to designate the individual and specify the provincial amount that you are transferring to him or her on Form T2202, T2202A, TL11A, TL11B, or TL11C. Enter the amount on line 20 below. Note: If you have a spouse or common-law partner, special rules may apply. See line 5856 in the forms book. Enter the amount you are transferring (cannot be more than line 19) Line 16 minus line 20

Provincial amount transferred 5920 – Unused provincial amount available to carry forward to a future year =

0.00 20 0.00 21

The person claiming the transfer should not attach this schedule to his or her return.

*

If you resided in another province or territory on December 31, 2008, enter on line 1 your unused federal tuition, education, and textbook amount from your 2008 notice of assessment or notice of reassessment.

RC-09-111

Name: Mary VINGTDEUX

SIN: 870-000-296

T1-2009

Working Income Tax Benefit

Schedule 6

See line 453 in the guide for more information. Complete this schedule and attach a copy of it to your return to claim the Working Income Tax Benefit (WITB) if you meet all of the following conditions in 2009: ** you were a resident of Canada throughout the year; ** you earned income from employment or business;and ** at the end of the year, you were 19 years of age or older, or you resided with your spouse or common-law partner or your child. In addition, to claim the basic WITB (Step 2), your working income must be more than $3,000 and more than $1,150 to claim the WITB disability supplement (Step 3). Refer to the chart at the bottom of the next page for the adjusted family net income levels to claim the WITB. You cannot claim the WITB if in 2009: ** you were enrolled as a full-time student at a designated educational institution for more than 13 weeks in the year, unless you had an eligible dependant at the end of the year; or ** you were confined to a prison or similar institution for a period of 90 days or more during the year. Tick this box if you were confined to a prison or similar institution for a period of 90 days or more during the year. Notes: If you were married or living in a common-law relationship but did not have an eligible spouse or an eligible dependant, complete this schedule using the instructions as if you had neither an eligible spouse nor an eligible dependant. If you are completing a final return for a deceased person who met the above conditions, you can claim the WITB for that person if the date of death was after June 30, 2009.

Step 1 – Calculating your working income and adjusted family net income
Do you have an eligible dependant? Do you have an eligible spouse? 381 Yes 382 Yes X X 1 1 No No 2 2

Part A – Working income
Complete columns 1 and 2 if you had an eligible spouse on December 31,2009. Otherwise, complete column 1 only. Employment income and other Employment income reported on line 101 and line 104 of the return Taxable part of scholarship income reported at line 130 Total self-employment income reported on lines 135, 137, 139, 141, and 143 of the return (excluding losses) Tax-exempt part of working income earned on a reserve and an allowance received as an emergency volunteer. Add lines 3 to 6. Enter the amount even if the result is "0". Add the amounts from line 7 in columns 1 and 2. Column 1 You Column 2 Your eligible spouse 3 4 384 + 5 + 3 4 5 6 7

383 + + 385 + =

35,480.00 0.00 0.00

35,480.00

6 386 + 7 387 = 8

0.00

Working income

35,480.00

Part B – Adjusted family net income
Net income amount from line 236 of the return. Tax-exempt part of all income earned/received on a reserve or an allowance received as an emergency volunteer. Total of Universal Child Care Benefit repayment (line 213 of the return) and registered disability savings plan income repayment (included in line 232). Add lines 9, 10, and 11. Total of Universal Child Care Benefit (line 117 of the return) and registered disability savings plan income (line 125 of the return). Line 12 minus line 13 (if negative, enter "0") Add the amounts from line 14 in columns 1 and 2. Are you claiming the basic WITB?
Are you claiming the WITB disability supplement

41,500.00 388 + + = – =

9 10 389 +

1,200.00

9 10

0.00 11 41,500.00 12

+ =

0.00 11 1,200.00 12 1,200.00 13 0.00 14

0.00 13 – 41,500.00 14 390 = 41,500.00 15

Adjusted family net income X 1 1 1 No No No 2 2 2

391 Yes 392 Yes 394 Yes

If yes, complete Step 2 on the back. If yes, complete Step 3 on the back. If yes, he or she must complete Step 1 and Step 3 on a separate Schedule 6.

for yourself?
Does your eligible spouse qualify for the disability

amount for himself or herself?

Name: Mary VINGTDEUX

SIN: 870-000-296

Step 2 – Calculating your basic WITB
If you had an eligible spouse, only one of you can claim the basic WITB. However, the individual who received the WITB advance payment for 2009 is the individual who must claim the basic WITB for the year. If you had an eligible dependant, only one individual can claim the basic WITB for that same eligible dependant. Enter the amount from line 8 in Step 1. Base amount Line 16 minus line 17 (if negative, enter "0") Rate Multiply line 18 by line 19.
If you had neither an eligible spouse nor an eligible dependant, enter $925. If you had an eligible spouse or an eligible dependant enter $1,680.

– = x =

35,480.00 3,000.00 32,480.00 25.0% 8,120.00

16 17 18 19 20

Enter the amount from line 20 or line 21, whichever is less. Enter the amount from line 15 in Step 1. Base amount: If you had neither an eligible spouse nor an eligible dependant, enter $10,500. If you had an eligible spouse or an eligible dependant, enter $14,500. Line 23 minus line 24, (if negative, enter "0") Rate Multiply line 25 by line 26.

1,680.00 21 1,680.00 => 41,500.00 23

1,680.00 22

– = x =

14,500.00 27,000.00 15.0% 4,050.00

24 25 26 => –

4,050.00 27 0.00 28

Line 22 minus line 27 (if negative, enter "0") = Enter the amount from line 28 on line 453 of your return, unless you complete Step 3

Step 3 – Calculating your WITB disability supplement
If you qualify for the disability amount for yourself, complete Step 3 to calculate your WITB disability supplement. However, if you had an eligible spouse and both of you qualify for the disability amount, your spouse must complete steps 1 and 3 on a separate Schedule 6 to calculate his or her WITB disability supplement and enter the amount on line 453 of his or her return. Enter the amount from line 7 in column 1 of Step 1 Base amount Line 29 minus line 30 (if negative, enter "0") Rate Multiply line 31 by line 32. Enter the amount from line 33 or $462.5, whichever is less. Enter the amount from line 15 in Step 1.
Base amount: If you had neither an eligible spouse nor an eligible dependant, enter $16,667. If you had an eligible spouse or an eligible dependant, enter $25,700

– = x =

35,480.00 29 1,150.00 30 34,330.00 31 25% 32 8,582.50 33 462.50 => 41,500.00 35

462.50 34

Line 35 minus line 36 (if negative, enter "0") Rate: If you had an eligible spouse and he or she also qualifies for the disability amount, enter 7.5%. Otherwise, enter 15%. Multiply line 37 by line 38. Line 34 minus line 39 (if negative, enter "0") If you completed Step 2, enter the amount from line 28. Otherwise, enter "0". Add lines 40 and 41.

– = x =

25,700.00 36 15,800.00 37 15.0% 38 2,370.00 => – = + =

2,370.00 39 0.00 40 0.00 41 0.00 42

Enter this amount on line 453 of your return.

Adjusted family net income levels
You had neither an eligible spouse nor

an eligible dependant Basic WITB Adjusted family net income (line 15 in Step 1) WITB disability supplement (you qualify for the disability amount) Adjusted family net income (line 15 in Step 1) WITB disability supplement (you had an eligible spouse and both of you qualify for the disability amount) Adjusted family net income (line 15 in Step 1) less than $16,667

You had an eligible spouse or an eligible dependant less than $25,700 less than $28,783

less than $19,750

---------->

less than $31,867

RC-09-111

Name: Mary VINGTDEUX

SIN: 870-000-296

T1-2009

Capital Gains (or Losses) in 2009

Schedule 3
5 Gain (or loss) (column 2 minus columns 3 and 4)

Read line 127 in the General Income Tax and Benefit Guide. For more information, read Chapter 2 in guide T4037, Capital Gains. Attach a separate sheet of paper if you need more space. Attach a copy of this schedule to your return. 1 2 3 4 Note: If you have a business investment Note: If you have a business investment loss, loss, Outlays and see line 217 in the General guide. Year of Proceeds of Adjusted cost base expenses (from dispositions) acquisition disposition

1. Qualified small business corporation shares (Report, in 3 below, publicly traded shares, mutual fund units, deferral of eligible small business corporation shares, and other shares ) Number Name of corp. and class of shares 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 .

Total 2. Qualified farm property and qualified fishing property Address or legal description Prov./Terr

106

0.00

Gain (or loss): 107

Total Mortgage foreclosures and conditional sales repossessions Address or legal description Prov./Terr

109

0.00

Gain (or loss): 110 +

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

123 0.00 Gain (or loss): 124 + Total 3. Publicly traded shares, mutual fund units, deferral of eligible small business corporation shares, and other shares (Report capital gains (or losses) shown on T5, T5013, T5013A, T4PS, and T3 information slips on line 174 or 176.) Number Name of fund/corp. and class of shares

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

From T1170
From Supplemental Sheet(including share percentage)

Total 4.Real estate, depreciable property, and other properties Address or legal description Prov./Terr

131

0.00 0.00 0.00

0.00

0.00 Gain (or loss) 132 +

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

60,000.00

55,000.00

Total

136

60,000.00

Gain (or loss) 138 +

5,000.00 0.00 0.00 0.00 5,000.00

Name: Mary VINGTDEUX

SIN: 870-000-296

Note: If you have a business investment loss, see line 217 in the General guide.

1 Year of acquisition

2 Proceeds of disposition

3 Adjusted cost base

4 Outlays and expenses (from dispositions)

5 Gain (or loss) (column 2 minus columns3 and 4)

5.Bonds, debentures, promissory notes, and other similar properties Name of issuer Face value Maturity date 0.00 0.00 0.00 0.00 0.00 0.00

From T1170 From Supplemental Sheet 151 Total 6.Other mortgage foreclosures and conditional sales repossessions Address or legal description Prov./Terr

0.00 0.00 0.00

0.00

0.00 Gain (or loss) 153 +

Total 7.Personal-use property (full description)

154

0.00

Gain (or loss) 155 +

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Gain only 158 + 8.Listed personal property (LPP) (full description)

Note: You can only apply LPP losses against LPP gains.

Subtract: Unapplied LPP losses from other years Net gain only 159 + 161 –

0.00

Capital gains deferral from qualifying dispositions of eligible small business corporation shares (included in 3 on page 1)

Farming and fishing income eligible for the capital gains deduction from the 173 disposition of eligible capital property (for details, see Form T657) T5, T5013, T5013A and T4PS Information slips - Capital gains (or losses) T3 information slip - Capital gains (or losses) Capital loss from a reduction in your business investment loss Total of all gains (or losses) in column 5 before reserves: Reserves from line 6706 of Form T2017 (if negative, show it in brackets and subtract it) Total capital gains (or losses): Taxable capital gains (or net capital loss) in 2009: Multiply the amount on line 197 by 50%. Enter the taxable capital gains on line 127 of your return. If it is a net capital loss, see line 127 in the guide.

174 176 178 191 192 197

+ + – = + =

0.00 0.00 5,000.00 0.00 5,000.00

199

2,500.00

RC-09-111

Name: Mary VINGTDEUX

SIN: 870-000-296

T1-2009

Statement of Investment Income

Schedule 4

State the names of the payers below and attach any information slips you received. Attach a separate sheet of paper if you need more space. Attach a copy of this schedule to your return.
I - Taxable amount of dividends (eligible and other than eligible) from taxable Canadian corporations Amount from information slips Taxable amount of dividends other than eligible dividends (specify):

(see line 120 in the guide) 0.00 + + Add lines 1 to 3 and enter this amount on line 180 of your return 180 = 0.00 Taxable amount of eligible dividends (specify): Amount from information slips 0.00 + + + Add lines 4 to 7 and enter this amount on line 120 of your return. 120 = 0.00

1 2 3 4 5 6 7

II - Interest and other investment income (see line 121 in the guide) Specify: Amount from T5 slips Interest and other investment income from other slips Other Interest - Bank Interest - Bond Interest - Mortgage Interest - Trust Interest - Other Investment income from joint accounts reported by the other individual(s)

+ + + + + +

4,020.00 0.00

Income from foreign sources:

+ + + + + + Enter this amount on line 121 of your return. 121 = (see line 122 in the guide)

4,020.00

III - Net partnership income (loss) Amount from T5013 slips

0.00 + + + + + Enter this amount on line 122 of your return. 122 =

0.00

IV - Carrying charges and interest expenses Amount from T5013 slips

(see line 221 in the guide) 0.00 + + + + + + + + Enter this amount on line 221 of your return. 221 =

Carrying charges (specify): Interest expenses (specify):

0.00

RC-09-111

Name: Mary VINGTDEUX

SIN: 870-000-296

T1-2009

RRSP Unused Contributions, Transfers, and HBP or LLP Activities

Schedule 7

Only complete this schedule and attach it to your return when one or more of the following situations applies: ** You will not be deducting on your return for 2009 all of the unused RRSP contributions (amount B) on your "2009 RRSP Deduction Limit Statement" on your latest notice of assessment, notice of reassessment, or Form T1028, RRSP Information for 2009. ** You will not be deducting on your return for 2009 all of the RRSP contributions you made from March 1, 2009, to March 1, 2010. ** You have transferred to your RRSP certain amounts you included in your income. ** You are designating contributions made to your RRSP as a 2009 repayment under the Home Buyer's Plan (HBP) or the Lifelong Learning Plan (LLP). ** You withdrew funds from your RRSP in 2009 under the HBP or the LLP. If none of these situations applies to you, do not complete this schedule. Just enter your total RRSP contributions on line 208 of your return. See line 208 in the guide for more information. PART A - Contributions
Unused RRSP contributions: amount B of your "2009 RRSP Deduction Limit Statement" on your latest notice of assessment, notice of reassessment, or Form T1028, RRSP Information for 2009 Total contributions * made to your RRSP or your spouse's or common-law partner's RRSP from:

0.00 1

500.00 2 (attach all receipts) 0.00 3 (attach all receipts) + Add lines 2 and 3 245 = 500.00 => + Total RRSP contributions: Add lines 1 and 4 = * Include your transfers and contributions that you are designating as a repayment under the HBP or the LLP. See the guide for the list of contributions to exclude. March 3, 2009, to December 31, 2009 January 1, 2010, to March 1, 2010 PART B - Repayments under the HBP and the LLP Contributions made to your RRSP from January 1, 2009, to March 1, 2010, that you are designating as your repayments under the HBP and the LLP for 2009. Do not include an amount you deducted or designated as a repayment on your 2008 return, or that was refunded to you. Also, do not include any contributions or transfers that you will be including on line 10 or 11 below. Repayment under the HBP 6 246 Repayment under the LLP 7 262 + Add lines 6 and 7 = 0.00 => – PART C - RRSP deduction RRSP contributions available to deduct: Line 5 minus line 8 RRSP contributions you are deducting for 2009 (not to exceed the lesser of the amount on line 9, excluding transfers , and your RRSP deduction limit for 2009, amount (A) of your "2009 RRSP Deduction Limit Statement" on your latest notice of Aassessment, notice of reassessment, or Form T1028, RRSP Information for 2009) 500.00 0.00 Transfers (see "Line 11 – Transfers" at line 208 in the guide) 240 + Add lines 10 and 11 = 500.00 2009 RRSP deduction: Enter the amount from line 9 or line 12, whichever is less. Also enter this amount on line 208 of your return.

500.00 4 500.00 5

0.00 8

=

500.00 9

10 11 12 208 – 500.00 13

PART D – RRSP unused contributions available to carry forward Your unused RRSP contributions available to carry forward to a future year: Line 9 minus line 13 = 0.00 14 We will show the amount of line 14 as amount (B) of your "2010 RRSP Deduction Limit Statement" on your 2009 notice of assessment. PART E - 2009 withdrawals under the HBP and the LLP HBP: enter the amount from box 27 of all your 2009 T4RSP slips
Tick this box if the address shown on page 1 of your return is the same as the address of the home you purchased under the HBP.

247 259 263 264 18 16

0.00 15

LLP: enter the amount from box 25 of all your 2009 T4RSP slips
Tick this box to designate that your spouse or common-law partner was the student for whom the funds were withdrawn under the LLP.

0.00 17

RC-09-111

Name: Mary VINGTDEUX

SIN: 870-000-296

T1- 2009

Tuition, Education, and Textbook Amounts
See line 323 in the guide for more information.

Schedule 11

Only the student can complete this federal schedule and attach it to his or her return. Use it to: • calculate your tuition, education and textbook amounts; • determine the amount available to transfer to a designated individual; and • determine the unused amount, if any, available for you to carry forward to a future year.

Tuition, education, and textbook amounts claimed by the student for 2009
Unused federal tuition, education, and textbook amounts from your 2008 notice of assessment or notice of reassessment Eligible tuition fees paid for 2009 0.00 320 10,000.00 2 1

Education and textbook amounts for 2009:
Calculating your part-time amount: use columns B of Forms T2202, T2202A, TL11A, TL11B,and TL11C. Do not include any month that is also included in column C. Only one claim per month (maximum 12 months) Education amount: Number of months from column B x $120 = 1,440.00 3 12 Textbook amount: Number of months from column B x $20 = + 12 240.00 4 = 1680.00 => 321 + 1,680.00 5 Line 3 plus line 4 Calculating your full-time amount: use column C of Forms T2202, T2202A, TL11A,TL11B, and TL11C. Only one claim per month (maximum 12 months) Education amount: Number of months from column C x $400 = 0.00 6 0 Textbook amount: Number of months from column C x $65 = + 0 0.00 7 = 0.00 => 322 + 0.00 8 Add lines 6 and 7 Total 2009 tuition, education, and textbook amounts: add lines 2, 5, and 8. = 11,680.00 => + Total available tuition, education, and textbook amounts: add lines 1 and 9. = Taxable income from line 260 of your return Total of lines 1 to 19 of your Schedule 1
(?)

11,680.00 9 11,680.00 10

Line 11 minus line 12 (if negative, enter "0") Unused tuition, education and textbook amounts claimed for 2009: Amount from line 1 or line 13, whichever is less – 0.00 => Line 13 minus line 14 = 8,986.06 15 2009 tuition, education, and textbook amounts claimed for 2009: Amount from line 9 or line 15, whichever is less + Total tuition, education, and textbook amounts claimed for 2009 : add lines 14 and 16. Enter this amount on line 323 of Schedule 1. =

– =

41,861.87 32,875.81 8,986.06

11 12 13

0.00 14

8,986.06 16 8,986.06 17

Transfer / Carryforward of unused amount Amount from line 10 Amount from line 17 Total unused amount

Line 18 minus line 19

– =

11,680.00 18 8,986.06 19 2,693.94 20

If you are transferring an amount to another individual, continue on line 21. Otherwise, enter the amount from line 20 on line 25. Enter the amount from line 9; if it is more than $5,000, enter $5,000. 5,000.00 – 8,986.06 Amount from line 16 Line 21 minus line 22 (if negative, enter "0") = 0.00 Maximum transferable You can transfer all or part of the amount on line 23 to your spouse or common-law partner, or to your or your spouse or common-law partner's parent or grandparent. To do this, you have to designate the individual on your Form T2202, T2202A, TL11A, TL11B, or TL11C and specify the federal amount that you are transferring to him or her. Enter the amount you are transferring on line 24 below. Note: If your spouse or common-law partner is claiming an amount for you on line 303 or line 326 of his or her Schedule 1, you cannot transfer an amount to your or your spouse or common-law partner's parent or grandparent . Federal amount transferred (cannot be more than line 23) Unused federal amount available to carry forward to a future year

21 22 23

Line 20 minus line 24

327 – =

0.00 24 2,693.94 25

The person claiming the transfer should not attach this schedule to his or her return.

RC-09-111

Name: Mary VINGTDEUX

SIN: 870-000-296

CALCULATION OF CUMULATIVE NET INVESTMENT LOSS (CNIL) TO DECEMBER 31, 2009
Use this form if you had any investment income or investment expenses for 2009. Your CNIL reduces the amount of your cumulative gains limit for the year and may affect the allowable amount of your capital gains deduction. Even if you are not claiming a capital gains deduction in 2009, you should still complete this form if you had any investment income or expenses in 2009. Because the balance in your CNIL account is a cumulative total, you may need this information in a future year. Keep a copy for your records and attach another to your return. If you need more information, contact us at 1-800-959-8281.

Note If you have capital gains other than from the disposition of qualified farm property, qualified fishing property or qualified small business corporation shares in 2009, you should start by completing Chart A on the back of this form to determine if you have additional investment income to include when you calculate your CNIL. Part 1 - Investment expenses claimed on your 2009 return Carrying charges and interest expenses (from line 221) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Net rental losses (from line 126) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . + Limited or non-active partnership losses (from line 122) other than allowable capital losses . . . . . . . . . +. . . . Limited partnership losses of other years after 1985 (from line 251) . . . . . . . . . . . . . . . . . . . . . . . . . . . .+. . 50% of exploration and development expenses (from line 224) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . + . . Any other investment expenses claimed in 2009 to earn property income (see the list of other investment expenses below) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6808 + Additional investment expenses: If you did not complete Chart A on the back of this form, enter "0." Otherwise, enter the lesser of line 15 in Chart A, or the amount you claimed on line 253 of your return. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . + Total investment expenses claimed in 2009 (total of lines 1 to 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .= . 0.00 0.00 0.00 0.00 0.00 1 2 3 4 5 6

0.00 7 0.00 =>

0.00 A

Part 2 - Investment income reported on your 2009 return Investment income (from lines 120 and 121) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Net rental income, including recaptured capital cost allowance (from line 126) . . . . . . . . . . . . . . . . . . . .+. . Net income from limited or non-active partnership (from line 122) other than taxable capital gains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . + Any other property income reported in 2009 (see the list of other property income below), including annuity payments taxable under paragraph 56(1)(d) minus the capital portion deducted under paragraph 60(a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6810 + . 50% of income from the recovery of exploration and development expenses (from line 130) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6811 + Additional investment income: If you did not complete Chart A on the back of this form, enter "0." Otherwise, enter the amount from line 15 in Chart A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .+ . Total investment income reported in 2009 (total of lines 8 to 13) . . . . . . . . . . . . . . . . . . . . = 4,020.00 8 0.00 9 0.00 10

11 12 2,500.00 13 6,520.00 =>

6,520.00 B

Other investment expenses Include: • repayments of inducements • repayments of refund interest • the uncollectible portion of proceeds from dispositions of depreciable property (except passenger vehicles that cost more than $30,000) • sale of agreement for sale or mortgage included in proceeds of disposition in a previous year under subsection 20(5) • foreign non-business tax under subsections 20(11) and 20(12) • life insurance premiums deducted from property income • capital cost allowance claimed on certified films and videotapes • farming or fishing losses claimed by a non-active partner or a limited partner. Do not include: • expenses incurred to earn business income • repayment of shareholders' loans deducted under paragraph 20(1)(j) • interest paid on money borrowed to: i) buy an income-averaging annuity contract; ii) pay a premium under a registered retirement savings plan; iii) make a contribution to a registered pension plan; and iv) make a contribution to a deferred profit-sharing plan.

Other property income Include: • amounts from insurance proceeds for the recapture of capital cost allowance (other than amounts already included on line 9) • home insulation or energy conversion grants under paragraph 12(1)(u) • payments received as an inducement or reimbursement • income from the appropriation of property to a shareholder • farming and fishing income reported by a non-active or a limited partner • other income from a trust • allowable capital losses included in partnership losses of other years after 1985 • amounts withdrawn from Net Income Stabilization Account (NISA) Fund 2. Do not include: • income amounts that relate to business income • payments received from an income-averaging annuity contract • payments received from an annuity contract bought under a deferred profit-sharing plan • shareholders' loans included in income under subsection 15(2).

Do not use this area 6813

Name: Mary VINGTDEUX

SIN: 870-000-296

Part 3 - Cumulative net investment loss (CNIL) Total investment expenses claimed in 2009 (from line A in Part 1) . . . . . . . . . . . . . . . . . . . . . . . . Total investment expenses claimed in previous years (after 1987): Enter the amount from line 16 in Part 3 of Form T936 for 2008. If you did not complete Form T936 for 2008, see note 1 below. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cumulative investment expenses (total of lines 14 and 15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Total investment income reported in 2009 (from line B in Part 2) . . . . . . . . . . . . . . . . . . . . . . . . . . Total investment income reported in previous years (after 1987): Enter the amount from line 19 in Part 3 of Form T936 for 2008. If you did not complete Form T936 for 2008, see note 2 below. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cumulative investment income (total of lines 17 and 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.00 14

+ =

0.00 15 0.00 => 6,520.00 17

0.00 16

+ =

0.00 18 6,520.00 => –

6,520.00 19 0.00 C

Cumulative net investment loss (CNIL) to December 31, 2009 (line 16 minus line 19; if negative, enter "0") . . . . . . . . .= . . . . If you are claiming a capital gains deduction on your 2009 return, enter the amount from line C on line 28 of Form T657 for 2009.

Notes 1. To calculate your total investment expenses from previous years, complete Part 1 of Form T936 for each year from 1988 to 2008 in which you had investment expenses (do not complete line 7 for 1988 to 1991). Add the amounts from line A and enter the total on line 15 above. 2. To calculate your total investment income from previous years, complete Part 2 of Form T936 for each year from 1988 to 2008 in which you had investment income (do not complete line 13 for 1988 to 1991). Add the amounts from line B and enter the total on line 18 above.

Chart A Enter the amount from line 199 of Schedule 3 (if negative, show it in brackets) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enter the amount from line 173 of Schedule 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Line 1 plus line 2 (if negative, enter "0"). If the amount on this line is zero, do not complete lines 4 to 14, and enter "0" on line 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enter the amount from line 1 above (if negative, enter "0") . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enter the total of the amounts from lines 107, 110, and 124 of Schedule 3 (if negative, show it in brackets) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.00 If you reported an amount on line 192 of Schedule 3, enter the total of the amounts from lines 6683 and 6690 on Form T2017. Otherwise, enter the amount from line 5 on line 7. . . . . . . . . + Line 5 plus line 6 (if negative, enter "0") . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . = 0.00 Enter 1/2 of line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Line 4 minus line 8 (if negative, enter "0"). If the amount on this line is zero, do not complete lines 10 to 14, and enter "0" on line 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Total net non-eligible taxable capital gains (line 3 or line 9, whichever is less). If the amount on this line includes an amount from a T3 slip, complete lines 11 to 13 below. Otherwise, enter "0" on line 14. . . . . . . . . . . . . . . . . . . . . . . . Enter the amount from box 21 of all 2009 T3 slips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enter the amount from box 30 of all 2009 T3 slips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . – 5365 = Line 11 minus line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enter 1/2 of line 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Additional investment income (line 10 minus line 14; if negative, enter "0") . . . . . . . . . . . . . . . . . . . . . . . . . . . . + = 2,500.00 1 0.00 2 2,500.00 3 2,500.00 4 5 6 7 – = 0.00 8 2,500.00 9 2,500.00 10

0.00 11 0.00 12 0.00 13 . – = 0.00 14 2,500.00 15

RC-09-111

Name: Mary VINGTDEUX

SIN: 870-000-296

Nova Scotia Equity Tax Credit
Complete this form to calculate your Nova Scotia equity tax credit. This credit can be used to reduce your Nova Scotia tax payable. You can claim this credit for investments in eligible shares you acquired in 2009 (that you did not claim on your 2008 return) or in the first 60 days of 2010. You can carry unused credits forward for seven years or back three years. The maximum credit you can claim is $15,000 per tax year including any unused amounts from other years. Attach a copy of Form NSETC-1 to this form and include it with your return. If you are filing electronically, keep a copy of the documents for your records in case we need to see them. Part 1 - Nova Scotia Equity Tax Credit claim for 2009 Credit amount from Form NSETC-1 Unused Nova Scotia equity tax credit from your 2008 notice of assessment or notice of reassessment Add lines 1 and 2 Enter the amount from line 3, if it is more than $15,000, enter $15,000. 6220 + = Tax year => 2009

1500.00

1 2 3 4

Total credit available Maximum allowable for 2009

1500.00 1500.00

Enter the amount from line 80 of Form NS428, Nova Scotia Tax and Credits, or, if you have to pay tax to more than one jurisdiction, from line 65 in Part 4, Section NS428MJ, of Form T2203, Provincial and Territorial Taxes for 2009 – Multiple Jurisdictions . Enter the amount from line 4 or line 5, whichever is less. Enter this amount on line 81 of Form NS428 or on line 66 in Part 4, Current-year claim Section NS428MJ, of Form T2203, whichever applies

0.00

5

0.00

6

Complete Part 2 if the amount of your current-year claim (line 6) is less than the total credit available (line 3) and you want to claim a carryback of the unused credit or calculate the amounts available to carry forward to future years. The carry-back provisions allow you to apply unused credits against your Nova Scotia tax for the three previous tax years. The credit you apply cannot be more than your Nova Scotia tax for that year. The total of the credit you carry back to a previous year, plus any credit you have already claimed in that year, cannot be more than $15,000. Part 2 - Carryback and amount available to carry forward to future years Enter the amount from line 3 Enter the amount from line 6 Line 7 minus line 8 1500.00 0.00 1500.00 7 8 9

Total unused credit available

– =

6225 Enter the amount you want to carry back to 2008 6226 + Enter the amount you want to carry back to 2007 6227 + Enter the amount you want to carry back to 2006 Total unused credit applied to previous years Add lines 10, 11, and 12 =

10 150.00 11 150.00 12 88.43 388.43 => –

388.43 13

Line 9 minus line 13

Unused Nova Scotia equity tax credit available to carry forward to a future year

=

1111.57 14

Certification I certify that the information given on this form is correct and complete. dd/mm/yyyy Signature Date

RC-09-111


								
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