2016 Supplemental Forms Participants From 2015

Transcription

1 AgriStability Page Supplemental Forms Participants From 2015 Completed supplemental forms are required only for the AgriStability Program Name and Address 1. Print your full name and address in this section. 2. Complete this section if you would like someone other than Include a telephone/cell number where you can be reached. yourself to provide or receive information on your behalf. Participant Contact (Accountant, Spouse and/or Other) Name Business Name Contact Name Address Address Town/City Province Postal Code Town/City Province Postal Code Telephone (Daytime) Telephone (Evenings) ( ) ( ) Telephone (Daytime) Facsimile Number Cell Phone Facsimile Number ( ) ( ) ( ) ( ) address: Additional Contacts (Accountant, Spouse and/or other) Name Telephone Address Language: The participant is: (check all applicable boxes) AgriStability Pin # English a sole proprietor a member of a partnership Partnership Pin # French a corporation other: (if applicable) If member of a partnership, please list the names, social insurance numbers (SIN) of your partners: AgriStability Pin # Name SIN (corporations/cooperatives only) Business Number Sin # Province of main farmstead: Province of main residence as of December 31, 2016 If the corporation has been dissolved, please provide the date of dissolution: Production (Crop) Insurance (PI) Information Year Month Day PI Number: Have you been enrolled in the Production (Crop) Insurance Program? Yes No If yes, See Schedule 6. Do you purchase agricultural commodities for resale? Yes No If yes, see Schedule 3 Did you contract a producer to grow your potato seed? Yes No If yes, did you contract by the: acre cwt Did you have a contract to grow potato seed for another producer? Yes No Did you contract by the: acre cwt Are you an owner / partner / shareholder or manager of another farming operation? Yes No If so, what is the name of that operation(s)? PEI Agricultural Insurance Corporation PO Box 2000, Charlottetown, PEI, C1A 7N8

2 Confidential Information By submitting an application form for benefits under the AgriStability program, I: Certify that the information provided is complete and correct; Understand that entitlement to program benefits is dependant on meeting the criteria set out in the guidelines; Agree to notify the AgriStability Program Administration in writing of any changes to the income tax information provided to the Canada Revenue Agency (CRA) for the program year or any of the reference years within 60 days of my CRA Notice of Assessment; Acknowledge that additional AgriStability program payments will only be made for adjustments reported within 90 days from the date of mailing of the AgriStability reassessment Calculation of Program Benefits, except for changes that result from a reassessment of audit by the Federal and/or Provincial Government; Agree to repay any overpayment amount received if the amount exceeds the government contributions to which I am entitled under the AgriStability Program; * Understand that interest may be charged on overpayments at the rate of 12% per annum; Understand and agree that the information I submit may be combined with the information of other participants for the purpose of determining AgriStability benefits, and consent to the disclosure of information pertaining to me or my financial affairs to the other participants who are being combined with my information; Consent to the use and disclosure of the information contained in this form by officials from the P.E.I Department of Agriculture, and Agriculture and Agrifood Canada, to administer my application for the AgriStability Program, as well as for the purposes of audit, analysis and evaluation of the AgriStability Agreement; Consent to the disclosure of the information submitted on the application form to CRA for the purposes of ensuring that CRA's records are complete and accurate for the purposes of administering the Income Tax Act; Consent to the use of any information I have submitted to the Net Income Stabilization Account (NISA), the Canadian Farm Income Program (CFIP), and the Canadian Agricultural Income Satbilization (CAIS) Program in the administration of my application for AgriStability; Agree that the administration may verify the information submitted through the applicable third parties such as marketing boards and acreage registration bodies. ** Personal information on this form is collected under the Canada-Prince Edward Island Implementation Agreement for the Growing Forward 2 Agreement and will be used for the purposes of administering programs offered by the Agricultural Insurance Corporation. If you have any questions about this collection of personal infromation, you may contact the Director, Farm Income Risk Management, Agricultural Innsurance Corporation, PO Box 2000, Charlottetown, PE, C1A 7N8, toll free Information may be verified.

3 Schedule 1 Statement of Purchased Inputs & Prepaids 2016 Taxation Year Check here if nothing to report - Complete this SCHEDULE ONLY if you file to Canada Revenue Agency on a CASH basis. - Do not include items if quantities do not change from year to year. - Do not include items if value is less than $ Use the end of 2016 taxation year estimated Fair market Value/per unit - Attach another page if required. Description Start of Year End of Year End of Year Quantity Quantity Fair Market Value (eg. tonnes, bushels) (eg. tonnes, bushels) Prepared Feeds / Supplements (including prepaids) ($/per unit) Fertilizer / Lime (including prepaids) Pesticides / Herbicides / Fungicides (including prepaids) Other (specify)

4 Schedule 2a - page Perishable Crop Inventory Worksheet by Sales Records Check here if nothing to report - Producers of perishable crops are required to complete Schedule 2a - Perishable crops are: potatoes, rutabagas, onions etc. - Include all perishable crops except those listed on Schedule 3. - Actual sales- record all sales(quantity and dollars) of perishable crops grown in the 2016 taxation year. Seed from your 2016 crop planted by applicant for 2017 crop: All Sales from the *2016 Crop Date Quantity Sold Amount Received/ Date Payment Sold (cwt, bu, etc.) Expected ($) Received/Expected Potatoes, Rutabagas, Onions (Please circle one or identify the perishable crop produced) **List inventory left in the warehouse and the amount dumped (include date dumped) * Producers who have a non-calendar year end may have to enter the sales from the 2015 crop year. Please contact the AgriStability administration if you have any questions. ** For inventory remaining in storage, please provide shipment information as soon as possible.

5 Schedule 2a - page Perishable Crop Inventory Worksheet by Sales Records Check here if nothing to report - Producers of perishable crops are required to complete Schedule 2a - Perishable crops are: potatoes, rutabagas, onions etc. - Include all perishable crops except those listed on Schedule 3. - Actual sales- record all sales(quantity and dollars) of perishable crops grown in the 2016 taxation year. - Attach another sheet if necessary. Seed from your 2016 crop planted by applicant for 2017 crop: All Sales from the *2016 Crop Date Quantity Sold Amount Received/ Date Payment Sold (cwt, bu, etc.) Expected ($) Received/Expected Potatoes, Rutabagas, Onions (Please circle one or identify the perishable crop produced) **List inventory left in the warehouse and the amount dumped (include date dumped) * Producers who have a non-calendar year end may have to enter the sales from the 2015 crop year. Please contact the AgriStability administration if you have any questions. ** For inventory remaining in storage, please provide shipment information as soon as possible.

6 Schedule 2b Crop Production and Inventory Record for the tax year of to 2016 Check here if nothing to report. - All crops produced on the farm, except those listed in Schedule 3, must be reported, including those produced, purchased and sold during the program year, - Producers of PERISHABLE CROPS are required to complete Schedule 2a Perishable Crop Inventory Worksheet; therefore, it is not necessary to duplicate beginning and ending inventory for PERISHABLE GOODS only. Tax Year On-farm Production Amount Fed, Tax Year Description Beginning Acres Quantity Purchases Sales used as Seed and/or Ending Inventory Produced Culled/dumped Inventory Crop (Specify) (specify units) # (specify units) (specify units) (specify units) (specify units) (specify units) Potatoes: list by variety Barley Mixed Grain Oats Wheat Soybeans Corn High Moisture Corn Round Hay Bales Square Hay Bales Round Silage Bales Grass Silage Piled Corn Silage Round Baled Straw Square Baled Straw - Include all crops produced on the farm, including those produced but not stored as inventory. - Include any purchased crops that may be in inventory at the beginning and/or the end of the year. - Sales and purchases must be verifiable. - Assess ending inventory. The following formula should be used as a check only: BEGINNING INVENTORY (+) QUANTITY PRODUCED (+) PURCHASES (-) SALES (-) AMOUNT FED (-) USED AS SEED (-) CULLED= ENDING INVENTORY.

7 Schedule 2c - page 1 Check here if nothing to report. Livestock Production and Inventory Record for the tax year of to 2016 Include all livestock except for those listed in Schedule 3. Make sure to include average weights of Calves and Feeder Cattle. Tax Year Beginning Tax Year Ending Inventory Births Purchases Sales Deaths Inventory Description Average Average Average Average # of Head Weight # of Head # of Head Weight # of Head Weight # of Head # of Head Weight Beef Bulls Beef Cows Beef Bred Heifers Calves born to Beef Cows & Heifers in 2016 Beef Open Heifers Beef Calves (under 400 lb) Beef Light Feeders( lb) Beef Medium Feeders( lb) Beef Heavy Feeders( lb) Heavy Feeders(>901 lb) Dairy Bulls Dairy Cows Calves born to Dairy Cows & Heifers Dairy Bred Heifers Dairy Open Heifers Dairy Calves Cattle for Personal Consumption * *Not counted as a sale in the structural change calculation. - Include all livestock on hand at the beginning of the year, any livestock born, purchased/sold (except those in Schedule 3), or died during the year. - Average weights of Feeder Cattle and Calves must be specified in the purchases and sales as well as beginning and ending inventories. - Count ending inventory. The following formula should be used as a check only: BEGINNING INVENTORY (+) BIRTHS (+) PURCHASES (-) SALES (-) DEATHS = ENDING INVENTORY. NOTE: WE MAY REQUIRE VERIFICATION OF SALES, PURCHASES AND BIRTHS.

8 Schedule 2c - page 2 Livestock Production and Inventory Record for the tax year of to 2016 Check here if nothing to report. Make sure to include average weights of Weaners, Growers and Finishers. Include all livestock except for those listed in Schedule 3. Tax Year Beginning Tax Year Ending Inventory Births Purchases Sales Deaths Inventory Description (a) Average Average Average (b) Average # of Head Weight # of Head # of Head Weight # of Head Weight # of Head Weight Swine: Boars Sows & Gilts Nursing (0-10 lbs) Weaners (11-30 lbs) Weaners (31-50 lbs) Growers ( lbs) Finishers ( lbs) Swine for Personal Consumption * Other (Specify): Contact Agristability office for suggested breakdown for other livestock Sheep, Mink, Poultry etc. *Not counted as a sale in the structural change calculation. - For other livestock, list male and female breeding stock and other classes or weight ranges. See beef, dairy and swine for examples. - Include all livestock on hand at the beginning of the year, any livestock born, purchased/sold (except those in Schedule 3), or died during the year. - Average weights of Weaners, Growers and Finishers must be specified. - Count ending inventory. The following formula should be used as a check only: BEGINNING INVENTORY (+) BIRTHS (+) PURCHASES (-) SALES (-) DEATHS (+ or -) TRANSFERS = ENDING INVENTORY. NOTE: WE MAY REQUIRE VERIFICATION OF SALES, PURCHASES AND BIRTHS.

9 Schedule 3 * Do not include the commodities already listed in Schedules 2a, 2b or 2c. Crops Check here if nothing to report. Commodities Purchased for Resale Quantity Purchased Tax Year Amount Quantity Sold Tax Year Amount Crop (Specify Units) Purchased ($) (Specify Units) Sold ($) Livestock Check here if nothing to report. e.g. Enter cattle purchased for resale in this section, if you kept the animal less than 60 days or the animal gained less than 90 kg (200 lb). # of Head Date Amount # of Head Date Amount Livestock Purchased Purchased ($) Sold Sold ($)

10 Schedule 4 Statement of Accounts Receivable and Deferred Income for 2016 Taxation Year (Money owed to you at year end) Check here if nothing to report. - Complete this schedule ONLY if you file to Canada Revenue Agency on a CASH basis. - Include shipments from schedule 2a (pages 1 and 2) in which payment has not yet been received. - If the account receivable is for a commodity, list the quantity sold. Crops (specify) Ending Receivables and 2016 Description Purchaser Quantity Income Deferred to Future Tax Years (cwt, mt, bushels, #of head) $$$ Livestock (specify) Production ( Crop) Insurance Other receivables Please make note if the Account Receivable is from other than the current Program year. Please be sure to include accounts receivable from prior years if they remain outstanding; even if they were reported in the prior year. Total

11 Schedule 5 Statement of Accounts Payable (unpaid expenses) for 2016 Taxation Year (Money you owed at year end) Check here if nothing to report. - Complete this schedule ONLY if you file to Canada Revenue Agency on a CASH basis. - If any of these items were on hand at the end of the year, they must also be included in ending inventory. - Do not include the interest portion of the accounts payable. - See the handbook for allowable expenses. Accounts Payable Vendor Description Quantity End of 2016 (fertilizer, pesticides, etc..) (cwt, mt, bushels, #of head) $$$ Total

12 Schedule 6 Name: AgriStability Pin #: Production (Crop) Insurance Information Please indicate the year (s) in which you were enrolled in the Production (Crop) Insurance Program What is your Production (Crop) Insurance number? What name (Corporation, Partnership, Farm Name or Given Name) is listed on your Production (Crop) Insurance Agreement? If you are enrolled or have been enrolled under more than one Name (Corporation, Farm Name, Partnership or Given Name) or Production Insurance Number, please list the Year, Name and Number included in the additional Agreement(s). If Corporation, please list names and Social Insurance Numbers of Shareholders Names SIN Please indicate the crop produced in 2015 as well as the Production Insurance Programs in Which you were enrolled in Crop Produced Program