- Do not submit this form - Name: Christine Templeman

SIN: 121 511 471

Printed: 2010/03/31 FEDERAL T1 2009

ENCL

Tax Return Enclosures List

Please assemble your return as described below and, where appropriate, sign and date the indicated forms. If you are using NETFILE to submit your return, DO NOT MAIL a paper copy of the return as well. However, be sure to keep all your slips, receipts, and supporting documents for six years in case CRA selects the return for review. If you are not using NETFILE, the following instructions apply: T1 - Income Tax and Benefit Return should be signed on the bottom of page 4. The following enclosures should be attached to the top left corner of page 3 of the T1 return: All tax information slips (T4, T3, T5, T4E, etc.) Official RRSP receipts (if photocopy, must be certified as true copy by issuer) Charitable donation receipts (including all e-receipts) Schedule 1 - Federal Tax Schedule 4 - Statement of Investment Income Schedule 9 - Donations and Gifts NL428 - Newfoundland and Labrador Tax and Credits Make sure you attach receipts for all the deductions or credits you are claiming. Keep all other supporting documents for six years in case the Canada Revenue Agency requests them. Additional instructions: If you have a correct personalized label from the CRA, affix it over the name and address section on page 1 of the return. Do not staple together returns of more than one taxpayer or returns of the same taxpayer for different years.

Note: Do not submit this enclosures list with your return.

Canada Revenue Agency

Agence du revenu du Canada

T1 GENERAL 2009
NL 7 Information about you Your social insurance number: 121 511 471 Your date of birth: 1967/06/10 Your language of correspondence: Votre langue de correspondance : English X Franais Marital status on December 31, 2009: 6. Single Information about your spouse or common-law partner (if applicable)

Identification
First name Last name Mailing Address: Apt. No. No./Street PO Box, RR City Prov./Terr. Christine Templeman

Income Tax and Benefit Return

18 Ways Rd P.O. Box 1069 Bonavista NL Postal code

A0C 1B0

Information about your residence Province or territory of residence on December 31, 2009: Newfoundland Province/territory where you currently reside if not the same as your mailing address above: NL Province or territory of self-employment: If you became or ceased to be a resident of Canada in 2009, give the date of: entry or departure:

His or her SIN: His/her first name: Enter his or her net income for 2009 to claim certain credits: Enter amount of Universal Child Care Benefit included on line 117 of his or her return: 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: If this return is for a deceased person, enter the date of death:
Do not use this area

Residency information for tax administration agreements

Did you reside in the Inuit communities of Rigolet, Nain, Hopedale, Makkovik, or Postville, or on Labrador Inuit Lands, on December 31, 2009? For more information, see Help. Yes
1

No

Elections Canada (see Help)

A) Are you a Canadian citizen? Yes X 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? Yes X Your authorization is valid until you file your next return. Your information will only be used for purposes permitted under the Canada Elections Act which includes sharing the information with provincial/territorial election agencies, Members of Parliament and registered political parties, as well as candidates at election time.
1

No

No

Goods and services tax/harmonized sales tax (GST/HST) credit application

See Help for details. Are you applying for the GST/HST credit (including any related provincial credit)? Yes X
1

No

777777770707070007373530321361000075214527335120000732125637551264007723610753176400077642573700545320752405577227457607662617164403211076024333442104550755363717472331107763735265431022077714350477131010746505162665711107726217570674510073636130311511220777777707000707007 777777770707070007736125333742232073220153520501300732221715027033207322035370270110071222371720723300732001517027013007320015170270130073200151702701300732001517027013007320015170270130073200151702341300776001153423057407360011170230530077070373317610000777777707000707007 777777770707070007737303407510230073200171722501320730003517227013207322017150050312075062173366121100732201515201431207720455174432570073404571166721320732041131041271207322217170016310073246313760121140736001157023453007320015170234130077373216057102230777777707000707007 777777770707070007753503226177410073200151702701300732001517027013007320015170270130073200151702341300776041157023457407324415574634574072615551646310300736401443033513007265511164734021072200551246210710723111516137002107231115161370021077535032241554030777777707000707007 777777770707070007734210127113550073232561757304400736725653573000007327212575374400077276161313340000736725653133440007327212571330044073636565317744000777270706473111107773707165731010077727060747311110767261707573100007773707075720001077261210073137400777777707000707007 777777770707070007336256111570230076725243155420000763520777015557207676243404757300075741507377750230726005643666133307673434266403330077734160645311010773134672551062107776102417155470076360244530155570773752521170000107214520777344220071241473337703220777777707000707007 777777770707070007663061040477132072025101563357000771753621071101107743426267613333074740052227175440772716454215574407454253237135444076434223325157720772720254213755007320703266157330077670617265573310773702127751676407367066522571110076630610404651130777777707000707007 777777770707070007722502577177441073733212571167300763612445331446607642516334471110074650563371024440716146676265577307316503775154211077715161666312320761614677154464007070226630115720077635247005755000737101646237572307534032672315773077235025651554420777777707000707007 777777770707070007355307722511321076726024542577540725020662101571007763742106137500072722026430011750767024225431554407673620755075777070700176331154200776074003733572307737130074715455076324074064411310777672535556472607236002430115300073750356237113230777777707000707007 777777770707070007267206647615774076542472601135440773235211571146707262310352041331074074227300111710735214563377532207570727267513330077313423255104760762271651464331107061000372631133072500646636457310777052122351557207622352116423555072672246656257770777777707000707007 777777770707070007713602327515650077024111732652210774461773702744507124017733441021071464377750450210777343243757000107262702021411330076624615750354550727651644615513007660511525442302074734016662655740746626635203655107526637746126555077306212377156700777777707000707007 666666660606060006226220224020062062260000240220620660264262240020006062466662644660066044200400262020622206420444024406446026666044066066044424626020000662606440046442006220420264424440066046422244400640662400006066020006400242622004402060260020262222400666666606000606006

Do not use this area

172

171

Name: Christine Templeman

SIN: 121 511 471

2 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? (see "Foreign Income" in Help for details) 266 If yes, attach a completed Form T1135. If you had dealings with a non-resident trust or corporation in 2009, see Help. Yes
1

No

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) Commissions included on line 101 (box 42 on all T4 slips) 102 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 (box 16 on the T4A(P) slip) 152 Other pensions or superannuation Elected split-pension amount (see Help and attach Form T1032) Universal Child Care Benefit (see Help) 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, included on line 120, from taxable Canadian corporations 180 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 Help) Rental income Gross Taxable capital gains (attach Schedule 3) Support payments received RRSP income (from all T4RSP slips) Other income Specify: Self-employment income (see Help) Business income Professional income Commission income Farming income Fishing income Total 160 Net 36,046 56 104 113 114 101 42,746 00

115 116 117 119 120 271 44

121 122 125 126 127 128 129 130 135 137 139 141 143

299 80

156

Taxable amount

Gross Gross Gross Gross Gross

162 164 166 168 170 144 145 146

Net Net Net Net Net

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 Add lines 101, 104 to 143, and 147. This is your total income.

147 150 43,317 24

Name: Christine Templeman

SIN: 121 511 471

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) 150 206 207 208 209 210 212 43,317 24

Registered pension plan deduction (box 20 on all T4 slips and box 32 on all T4A slips) RRSP deduction (see Schedule 7 and attach receipts) Saskatchewan Pension Plan deduction (maximum $600) Deduction for elected split-pension amount (see Help and attach Form T1032) Annual union, professional, or like dues (box 44 on all T4 slips, and receipts)

5,304 00

Universal Child Care Benefit repayment (box 12 on all RC62 slips) 213 Child care expenses (attach Form T778) 214 Disability supports deduction 215 Business investment loss Gross 228 Allowable deduction 217 Moving expenses 219 Support payments made Total 230 Allowable deduction 220 Carrying charges and interest expenses (attach Schedule 4) 221 Deduction for CPP or QPP contributions on self-employment and other earnings (attach Schedule 8) 222 Exploration and development expenses (attach Form T1229) 224 Other employment expenses 229 Clergy residence deduction 231 Other deductions Specify: 232 Add lines 207 to 224, 229, 231, and 232. 233 5,304 00 Line 150 minus line 233 (if negative, enter "0"). This is your net income before adjustments. Social benefits repayment (if you reported income on line 113, 119, or 146, see Help). Use the federal worksheet to calculate your repayment. Line 234 minus line 235 (if negative, enter "0"). If you have a spouse or common-law partner, see Help. This is your net income.

234 235 236

5,304 00 38,013 24

38,013 24

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

260

38,013 24

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

Name: Christine Templeman

SIN: 121 511 471

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) Provincial or territorial tax (attach Form 428, even if the result is "0") Add lines 420 to 428 This is your total payable. Total income tax deducted (see Help) Refundable Qubec abatement CPP overpayment (enter your excess contributions) Employment Insurance overpayment (enter your excess contributions) Refundable medical expense supplement 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 Provincial or territorial credits (attach Form 479 if it applies) Add lines 437 to 479. These are your total credits. 437 440 448 450 452 453 454 456 457 476 479 482 8,444 77 Line 435 minus line 482 8,444 77 (2,942 08) 8,444 77 420 421 422 428 435 3,223 29

2,279 40 5,502 69

Generally, we do not charge or refund a difference of $2 or less.

Refund

484

2,942 08

Balance owing Amount enclosed

485 486

Attach to page 1 a cheque or money order payable to the Receiver General. Your payment is due no later than April 30, 2010. Direct Deposit - Start or change (see Help) You do not have to complete this area every year. Do not complete it this year if your direct deposit information has not changed. Refund, GST/HST credit, 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. Notes: To deposit your CCTB payments (including certain related provincial or territorial payments) into the same account, also tick box 463. To deposit your UCCB payments into the same account, also tick box 491.
Branch number Institution number Account number CCTB UCCB

460

40543
(5 digits)

461

002
(3 digits)

462

0087122
(maximum 12 digits)

463

491

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.

490 Name: Address: Telephone:

For professional tax preparers only

Telephone

(709)468-7993

Date:

Do not use this area

487

488 Privacy Act Personal Information Bank number CRA PPU 005 Canada Revenue Agency Approval # : RC-09-107

Name: Christine Templeman

SIN: 121 511 471

T1-2009

Federal Tax

Schedule 1

Complete Step 1 to claim your federal non-refundable tax credits, Step 2 to calculate your federal tax on taxable income and Step 3 to calculate your net federal tax.

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

Step 1 Federal non-refundable tax credits (see Help) Basic personal amount Age amount (if you were born in 1944 or earlier) (use federal worksheet) Spouse or common-law partner amount (if negative, enter "0") $10,320 minus (his or her net income) Amount for an eligible dependant (attach schedule 5) (if negative, enter "0") $10,320 minus (his or her net income) Amount for children born in 1992 or later Number of children 366 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 17 on all T4 slips on self-employment and other earnings (attach Schedule 8) Employment Insurance premiums Canada employment amount (if you reported employment income on line 101 or line 104) Public transit amount Children's fitness amount Home renovation expenses (attach Schedule 12) Home buyers' amount Adoption expenses Pension income amount (see Help) Caregiver amount (use federal worksheet and attach Schedule 5) Disability amount (for self) (claim $7,196 or if you were under age 18, see Help) 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 Minus: $2,011 or 3% of line 236, whichever is less Subtotal (if negative, enter "0") Allowable amount of medical expenses for other dependants (attach Schedule 5) Add lines (A) and (B).

claim $10,320 (maximum $6,408)

300 301 303 305

10,320 00

1 2 3 4 5 6

x $2,089 =

367 306 308 310 312 363 364 365 368 369 313 314 315 316 318 319 323 324 326 1,942 67 731 79 1,044 00

(maximum $2,118.60) (maximum $731.79) (maximum $1,044)

7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

(maximum $2,000)

330 1,140 40 (A) 331 (B) 332 335 338 349 350 14,038 2,105 321 2,427 46 77 45 22 24 25 26 27 28

Add lines 1 to 24. Multiply the amount on the line above by 15%. Donations and gifts (attach Schedule 9) Total federal non-refundable tax credits

Go to Step 2 on page 2

Name: Christine Templeman

SIN: 121 511 471

Schedule 1
Page 2 of 2

Step 2 Federal tax on taxable income

Enter your taxable income from line 260 of your return. Use the amount on line 29 to determine which ONE of the following you have to complete. If the amount on line 29 is: 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 to 35. more than $40,726 but not more than $81,452 40,726 00 38,013 24 more than $81,452 but not more than $126,264 81,452 00 29

$40,726 or less 38,013 24 0 00 38,013 24 15% 5,701 99 0 00 5,701 99

more than $126,264 126,264 00 30 31 32 33 34 35 36

22% 6,109 00

26% 15,069 00

29% 26,720 00

Step 3 Net federal tax

Enter the amount from line 36 above. Federal tax on split income (from line 5 of Form T1206) Add lines 37 and 38. Enter your non-refundable tax credits from line 28. Federal dividend tax credit (see Help) Overseas employment tax credit (attach Form T626) Minimum tax carry-over (attach Form T691) Add lines 40 to 43. 5,701 99 424 404 350 425 426 427 5,701 99 2,427 22 51 48 42 43 2,478 70 429 405 3,223 29 2,478 70 3,223 29 44 45 46 40 41 37 38 5,701 99 39

Basic federal tax: line 39 minus line 44 (if negative, enter "0") Federal foreign tax credit (attach Form T2209) Subtotal: Basic federal tax minus foreign tax credits Recapture of investment tax credit (attach form T2038(IND)) Federal tax: Subtotal plus recapture of investment tax credit (if negative, enter "0") Federal logging tax credit Total federal tax: Federal tax minus logging tax credit (if negative, enter "0") Total federal political contributions (attach receipts) 409 Federal political contribution tax credit (see Help) 410 Investment tax credit (attach Form T2038(IND)) 412 Labour-sponsored funds tax credit Net cost 413 Allowable credit 414 Add lines 48 to 50. 416 Line 47 minus line 51 (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 52 to 54. Enter this amount on line 420 of your return.

406

3,223 29 3,223 29

47

48 49 50 51 417 415 418 420 3,223 29 52 53 54 55

3,223 29

Name: Christine Templeman

SIN: 121 511 471

T1-2009

Schedule 4

Statement of Investment Income

State the names of the payers below and attach any information slips you received. Attach a copy of this schedule to your return. I - Taxable amount of dividends (eligible and other than eligible) from taxable Canadian corporation (see line 120 in Help) Taxable amount of dividends other than eligible dividends (specify): Amounts from information slips (see S4-SUPP)

Add lines 1 to 3 and enter this amount on line 180 of your return. Taxable amount of eligible dividends (specify): Amounts from information slips (see S4-SUPP)

180 271 44

1 2 3 4 5 6 7

Add lines 4 to 7 and enter this amount on line 120 of your return. II - Interest and other investment income (see line 121 in Help) Specify: Amounts from information slips (see S4-SUPP)

120

271 44

299 80

Income from foreign sources: Amounts from information slips (see S4-SUPP)

Enter this amount on line 121 of your return. III - Net partnership income (loss) (see line 122 in Help) Amounts from T5013 slips Enter this amount on line 122 of your return. IV - Carrying charges and interest expenses (see line 221 in Help) Amounts from T5013 slips

121

299 80

122

Interest on money borrowed to earn interest, dividend and royalty income Interest on money borrowed to acquire an interest in a limited partnership or a partnership in which you are not an active partner Enter this amount on line 221 of your return. 221

Name: Christine Templeman

SIN: 121 511 471 S4-SUPP

Schedule 4 - Supplementary Statement

Investment Income From Information Slips
Other Than Eligible Dividends T5: Scotiabank T5: canada savings bonds T5: sun life financial Eligible Dividends Interest and Other 107 23 192 57 Foreign Sources

271 44

TOTAL

271 44

299 80

Name: Christine Templeman

SIN: 121 511 471

T1-2009

Schedule 9

Donations and Gifts

Attach a copy of this schedule to your return along with the official receipts that support your claim. Remember, you may have charitable donations shown on your T4 and T4A slips. See Help for more information. Total eligible amount of charitable donations and government gifts Enter your net income from line 236 of your return. 38,013 24 x 75% = 1,205 00 28,509 93 1 2

Note: If the amount on line 1 is less than the amount on line 2, enter the amount from line 1 on line 340 below and continue completing the schedule from line 340. Gifts of depreciable property (see Help) Gifts of capital property (see Help) Add lines 3 and 4. 337 339 3 4 5 28,509 93 6

x 25% = Total donations limit: add lines 2 and 5 (not to exceed the amount on line 236 of your return)

Allowable charitable donations and government gifts (enter the amount from line 1 or line 6, whichever is less) Eligible amount of cultural and ecological gifts (see line 349 in Help) Add lines 340 and 342. Enter $200, or the amount from line 344, whichever is less. Line 344 minus line 345

340 342 344 345 347

1,205 00

1,205 00 200 00 x 15% = 346 1,005 00 x 29% = 348 Donations and gifts: add lines 7 and 8. Enter this amount on line 349 of Schedule 1.

30 00 291 45 321 45

7 8 9

Name: Christine Templeman

SIN: 121 511 471

NL428
T1 General - 2009

Newfoundland and Labrador Tax and Credits

Complete this form and attach a copy of it to your return. For details, see Help.

Step 1 - Newfoundland and Labrador non-refundable tax credits

For internal use only Basic personal amount claim $7,778 Age amount (if born in 1944 or earlier) (maximum $3,655) Spouse or common-law partner amount Base amount 6,992 00 Minus: his or her net income Result: (if negative, enter "0") (maximum $6,356) Amount for an eligible dependant Amount for infirm dependants age 18 or older Canada Pension Plan or Qubec Pension Plan contributions: (amount from line 308 of your federal Schedule 1) (amount from line 310 of your federal Schedule 1) Employment Insurance premiums (amount from line 312 of your federal Schedule 1) Adoption expenses Pension income amount (maximum $1,000) Caregiver amount Disability amount (for self) Disability amount transferred from a dependant Interest paid on your student loans (amount from line 319 of your federal Schedule 1) Your tuition and education amounts [attach Schedule NL(S11)] Tuition and education amounts transferred from a child Amounts transferred from your spouse or common-law partner [attach Schedule NL(S2)] Medical expenses from line 330 of your federal Schedule 1 Enter $1,694 or 3% of net income from line 236 of your return, whichever is less. Line 18 minus line 19 (if negative, enter "0") Allowable amount of medical expenses for other dependants (see Help) Add lines 20 and 21. Add lines 1 to 17 and 22, plus line 8 of RC269. Non-refundable tax credit rate Multiply line 23 by line 24. Donations and gifts: Amount from line 345 of your federal Schedule 9 Amount from line 347 of your federal Schedule 9 Add lines 26 and 27. Add lines 25 and 28. Enter this amount on line 41. 5868 1,140 40 5600 5804 5808 7,778 00 1 2

5812 5816 5820 5824 5828 5832 5833 5836 5840 5844 5848 5852 5856 5860 5864 18 19 20 21 1,942 67 731 79

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

5872 5876

22 5880 10,452 46 5884 10,452 46 7.7% 804 84 23 24 25

200 00 1,005 00

x 7.7% = x 15.5% = 5896

15 40 155 78 171 18

26 27 171 18 6150 976 02 28 29

Newfoundland and Labrador non-refundable tax credits

Go to Step 2 on the next page

Name: Christine Templeman

SIN: 121 511 471

NL428
Page 2 of 3

Step 2 Newfoundland and Labrador tax on taxable income

Enter your taxable income from line 260 of your return. Use the amount at line 30 to determine which ONE of the following columns you have to complete. Enter the amount from line 30 in the applicable column. 0 00 Line 31 minus line 32 (cannot be negative) 7.7% Multiply line 33 by line 34. 0 00 Add lines 35 and 36. Newfoundland and Labrador tax on taxable income Go to Step 3 If line 30 is more than $31,061, but not more than $62,121 38,013 24 31,061 00 6,952 24 12.8% 889 89 2,392 00 3,281 89 Go to Step 3 38,013 24 30

If line 30 is $31,061 or less 31 32 33 34 35 36 37

If line 30 is more than $62,121 31 32 33 34 35 36 37 Go to Step 3 62,121 00 15.5% 6,367 00 31 32 33 34 35 36 37

Step 3 - Newfoundland and Labrador tax

Enter your Newfoundland and Labrador tax on taxable income from line 37. Enter your Newfoundland and Labrador tax on split income from Form T1206. Add lines 38 and 39. Enter your Newfoundland and Labrador non-refundable tax credits from line 29. NL dividend tax credit: Credit calculated NL overseas employment tax credit: Amount from line 426 of federal Schedule 1 x 51.3% = NL minimum tax carryover: Amount from line 427 of federal Schedule 1 x 51.3% = Add lines 41 to 44. Line 40 minus line 45 (if negative, enter "0") NL additional tax for minimum tax purposes: Amount from line 117 of Form T691 x 51.3% = Add lines 46 and 47. Enter the provincial foreign tax credit from Form T2036. Line 48 minus line 49 (if negative, enter "0") 976 02 6152 6153 6154 1,002 49 26 47 3,281 89 6151 3,281 89 41 42 43 44 1,002 49 2,279 40 45 46 47 48 49 50 38 39 40

2,279 40

2,279 40

Political contribution tax credit Newfoundland and Labrador political contributions made in 2009 Credit calculated for line 52 on the Provincial Worksheet Line 50 minus line 52 (if negative, enter "0") Labour-sponsored venture capital tax credit Enter the credit amount from the Certificate(s) NL LSVC-1 (see Help). Line 53 minus line 54 (if negative, enter "0") Direct equity tax credit Enter the direct equity tax credit from Form T1272. Line 55 minus line 56 (if negative, enter "0") NL resort property investment tax credit Enter the resort property investment tax credit from Form T1297. Line 57 minus line 58 (if negative, enter "0")

6175 (maximum $500)

51 2,279 40 52 53

6176 2,279 40

54 55

2,279 40

56 57

2,279 40 Continue on the next page

58 59

Name: Christine Templeman

SIN: 121 511 471

NL428
Page 3 of 3

Step 3 - Newfoundland and Labrador tax (continued)

Newfoundland and Labrador 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 this tax reduction. Only one of you can claim it for your family. However, any unused amount can be claimed by the other person. Enter the amount from line 59 on the previous page. X Check this box to claim the tax reduction on your return Unused low-income tax reduction from your spouse or common-law partner, if applicable Line 60 minus line 61 (if negative, enter "0") (If you claimed an amount on line 61, enter "0" on line 79.) 2,279 40 6186 2,279 40 60 61 62

Adjusted family income for the calculation of the Newfoundland and Labrador low-income tax reduction

Column 1 You

Column 2 Your spouse or common-law partner 63 63

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 63 and 64. Total of the Universal Child Care Benefit income (line 117 of the return) and the registered disability savings plan income (line 125 of the return) Line 65 minus line 66 (if negative, enter "0") Add the amounts on line 67 in column 1 and column 2, if applicable. Enter the amount on line 74 below.

38,013 24

38,013 24

64 65 66 67 38,013 24

64 65 66 67 68

38,013 24 Adjusted net family income

Enter the amount from line 62 above. Basic reduction Reduction for your spouse or common-law partner Reduction for an eligible dependant claimed on line 5816 Add lines 70, 71, and 72. Adjusted family income Enter the amount from line 68 above. If you claimed an amount on lines 71 or 72, enter $26,625; otherwise, enter $15,911. Line 74 minus line 75 (if negative, enter "0") Applicable rate Multiply line 76 by line 77. Line 73 minus line 78 (if negative, enter "0") Line 69 minus line 79 (if negative, enter "0") Enter the result on line 428 of your return. claim $558 claim $280 claim $280 (maximum $838) 6187 6188 6189 558 00 558 00 70 71 72 73

2,279 40

69

38,013 24 15,911 00 22,102 24 16% 3,536 36 Newfoundland and Labrador low-income tax reduction

74 75 76 77 3,536 36 78 79 2,279 40 80

Newfoundland and Labrador tax

Unused low-income tax reduction that can be claimed by your spouse or common-law partner Amount from line 79 Amount from line 60 Line 81 minus line 82 (if negative, enter "0") 81 82 83

2,279 40 Unused amount

Name: Christine Templeman

SIN: 121 511 471

Direct Deposit Request - Individuals

Use this form to start direct deposit the following amounts: . your income tax refund, goods and services tax/harmonized sales tax credit (GST/HST) including certain related provincial payments, Working Income Tax Benefit advance payments (WITB), and any other deemed overpayment of tax to which you are entitled or to which you may become entitled; . your Canada Child Tax Benefit (CCTB) payments including certain related provincial and territorial payments; and . your Universal Child Care Benefit payments. Also use this form to change information you already provided to the Canada Revenue Agency. See Help for more information.

T1-DD (1)

Identification
First name and initial Last name Christine Templeman Mailing address: Apt. No. - Street No. Street name 18 Ways Rd PO Box P.O. Box 1069 City Prov./Terr. Bonavista NL Check the box(es) below to show your choice(s). Your SIN 121 511 471 Is this a new address? 1 No X If yes, enter the date you moved.

Yes Postal code A0C 1B0

Income tax refund, GST/HST credit, WITB advance payments, and any other deemed overpayment of tax
X Check this box to have your income tax refund, GST/HST credit, WITB advance payments, and any other deemed overpayment of tax deposited into your bank account held in Canada. Attach a blank cheque with the banking information encoded on it and write "VOID" across the front, or complete the banking information area below (see the example in Help). Branch number (5 digits) 40543 Institution number (3 digits) 002 Account number (maximum 12 digits) 0087122

460

461

462

Canada Child Tax Benefit (CCTB)

463 X Check this box to have your CCTB payments deposited into the same bank account held in Canada as your income tax refund, GST/HST credit, WITB advance payments, and any other deemed overpayment of tax. Check this box to have your CCTB payments deposited into a different bank account held in Canada. Attach a blank cheque with the banking information encoded on it and write "VOID - CCTB" across the front, or complete the banking information area below (see the example in Help). Branch number (5 digits) 471 472 Institution number (3 digits) 473 Account number (maximum 12 digits)

Universal Child Care Benefit (UCCB)

491 492 Check this box to have your UCCB payments deposited into the same bank account held in Canada as your income tax refund, GST/HST credit, WITB advance payments, and any other deemed overpayment of tax. Check this box to have your UCCB payments deposited into the same bank account held in Canada as your CCTB payments. Check this box to have your UCCB payments deposited into a different bank account held in Canada. Attach a blank cheque with the banking information encoded on it and write "VOID - UCCB" across the front, or complete the banking information area below (see the example in Help). Branch number (5 digits) 493 494 Institution number (3 digits) 495 Account number (maximum 12 digits)

Certification
I, as the person entitled to receive the payments, authorize the Receiver General to deposit the payments described above into the above-noted bank account(s) until further notice.

Signature

Telephone number

Date

Name: Christine Templeman

SIN: 121 511 471 OTHER

Other Income, Deductions and Credits

Other Income - Line 130 T4A - Box 18: Lump sum payments T4A - Box 24: Annuities (non-qualifying) T4A - Box 26: Eligible retiring allowances T4A - Box 27: Non-eligible retiring allowances T4A - Box 28: Other income - Scholarships Less: Tax exemption Taxable portion of scholarships T4A - Box 28: Revoked Deferred Profit Sharing Plan T4A - Box 28: Disability benefits from a superannuation or pension plan T4A - Box 28: Tax deferred cooperative share T4A - Box 28: Apprenticeship incentive or completion grant T4A - Box 28: Variable pension benefits T4A - Box 28: Periodic payments from an unregistered plan T4A - Box 28: Tax-Free Savings Account (TFSA) taxable amount T4A - Box 28: Other income - Other T4A - Box 30: Patronage allocations due to business purchases T4A - Box 40: RESP accumulated income payments T4A - Box 42: RESP educational assistance payments T4A-RCA - Statement of distribution from an RCA T3 - Box 22: Lump sum pension benefits T3 - Box 25: Foreign non-business income - Other T3 - Box 26: Other income T4A - Box 28: Other income - Death benefits T3 - Box 35: Eligible death benefits Less: Tax exemption Taxable portion of death benefits T4RIF - Box 16: Taxable amounts (non-qualifying) T4RIF - Box 18: Deemed receipt by annuitant - Deceased T4RIF - Box 20: Deemed receipt by annuitant - Deregistration T4RIF - Box 22: Other income T5013 - Box 30: Other income Negative balances from Canadian resource expenditure pools (form T1229) Other income from foreign slips Other: Total Other Income - to line 130 of your return

+ =

Other Deductions - Line 232 Undeducted and excess RRSP contributions (line 11, Form T746) Undeducted RRSP contributions withdrawn (using form T3012A) Legal/Acctg. exp. to appeal income tax assess. or respond to CRA reviews Legal expenses relating to support payments Deduction under section 20(11) Deduction under section 20(12) Canada or Qubec pension plan benefits paid back Old age security paid back (Box 20 of T4A(OAS) slip) Net federal supplements paid back Employment insurance benefits paid back (Box 30 of T4E slip) Registered disability savings plan (RDSP) income repayment Scholarships paid back Shareholder's loan amounts paid back Continued on page 2

Name: Christine Templeman

SIN: 121 511 471 OTHER

Page 2 of 2

Other Deductions - Line 232, continued Canadian motion picture film and videotape write-offs RCA deductions under subsection 60(t) and 60(u) Split income of a child under 18 (from Form T1206) T4RIF - Box 22: Other deductions T4RSP - Box 28: Other deductions Depletion allowances (from Form T1229) Post-death decrease in the value of an unmatured RRSP or a RRIF Other: Total Other Deductions - to line 232 of your return

Additional Deductions - Line 256 Non-taxable tuition assistance (Box 21 of T4E slip) Vow of perpetual poverty Exempt portion (15%) of U.S. social security benefits Other income exempt under a tax treaty Other income exempt under a tax treaty - from slips Employment with a prescribed international organization Other: Total Additional Deductions - to line 256 of your return

Total Income Tax Deducted - Line 437 From all information slips Plus T1032 line N - pension transferee Subtotal Less T1032 line N - pensioner Total 8,444 77 8,444 77 8,444 77