3 Elections Canada (see the Elections Canada page in the tax guide for details or visit

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1 {} Canada Revenue Agency Income Tax and Benefit Return T1 ENERAL 2011 Identification NL 7 First name and initial FRE Last name JANES Mailing address: Apt No - Street No Street name PO Box City RR Prov./Terr. Postal code Information about your residence Enter your province or territory of residence on ecember 31, 2011: Enter the province or territory where you currently reside if it is not the same as your mailing address above: If you were self-employed in 2011, enter the province or territory of self-employment: If you became or ceased to be a resident of Canada for income tax purposes in 2011, enter the date of: MM MM entry or departure Information about you Enter your social insurance number (SIN) if it is not on the label, or if you are not attaching a label: Year Month ay Enter your date of birth: Your language of correspondence: Votre langue de correspondance: English X Français Marital status Tick the box that applies to your marital status on ec. 31, 2011: 1 Married 2 Living common-law 3 Widowed 4 ivorced 5 Separated 6 Single Information about your spouse or common-law partner (if you ticked box 1 or 2 above) Enter his or her SIN: Enter his or her first name: Enter his or her net income for 2011 to claim certain credits: Enter the amount of Universal Child Care Benefit (UCCB) from line 117 of his or her return: Enter the amount of UCCB repayment from line 213 of his or her return: Tick this box if he or she was self-employed in 2011: 1 Person deceased in 2011 If this return is for a deceased Year Month ay person, enter the date of death: o not use this area Residency information for tax administration agreements For more information, see Information Sheet T1-NL01(E), Residency information for tax administration agreements, included in this tax package. id you reside in the Inuit communities of Rigolet, Nain, Hopedale, Makkovik, or Postville, or on Labrador Inuit Lands, on ecember 31, 2011? Yes 1 No 2 3 Elections Canada (see the Elections Canada page in the tax guide for details or visit A) Are you a Canadian citizen? Yes 1 No 2 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 1 No 2 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 include sharing the information with provincial/territorial election agencies, members of Parliament and registered political parties, as well as candidates at election time. oods and services tax/harmonized sales tax (ST/HST) credit application See the guide for details. NL Newfoundland & Labrador /12/12 Are you applying for the ST/HST credit (including any related provincial credit)? Yes 1 No 2 X X o not use this area 5001-R

2 FRE JANES SIN: Please answer the following question: id you own or hold foreign property at any time in 2011 with a total cost of more than CAN$100,000? (see the ''Foreign income'' section in the guide for details) Yes 1 No 2 If yes, complete and attach Form T1135 to your return. If you had dealings with a non-resident trust or corporation in 2011, see the "Foreign income" section in the guide. As a resident of Canada, you have to report your income from all sources both inside and outside Canada. X Total income Employment income (box 14 of all T4 slips) 101 Commissions included on line 101 (box 42 of all T4 slips) 102 Other employment income 104 Old Age Security pension (box 18 of the T4A(OAS) slip) 113 CPP or QPP benefits (box 20 of the T4A(P) slip) 114 isability benefits included on line 114 (box 16 of the T4A(P) slip) 152 Other pensions or superannuation 115 Elected split-pension amount (attach Form T1032) 116 Universal Child Care Benefit (UCCB) 117 UCCB amount designated to a dependant 185 Employment Insurance and other benefits (box 14 of the T4E slip) 119 Taxable amount of dividends (eligible and other than eligible) from taxable Canadian corporations (attach Schedule 4) 120 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) 122 Registered disability savings plan income 125 Rental income ross 160 Net 126 Taxable capital gains (attach Schedule 3) 127 Support payments received Total 156 Taxable amount 128 1, See schedule OTHINC 7, RRSP income (from all T4RSP slips) 129 Other income: 130 Self-employment income Business income ross 162 Net 135 Professional income ross 164 Net 137 Commission income ross 166 Net 139 Farming income ross 168 Net 141 Fishing income ross 170 Net 143 Workers' compensation benefits (box 10 on the T5007 slip) 144 Social assistance payments 145 Net federal supplements (box 21 on the T4A(OAS) slip) 146 1, Add lines 144, 145, and 146 (see Line 250 in the guide) , , Add lines 101, 104 to 143, and 147. This is your total income , R

3 FRE JANES SIN: 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 , Pension adjustment (box 52 of all T4 slips and box 034 of all T4A slips) Registered pension plan deduction (box 20 of all T4 slips and box 032 of all T4A slips) 207 RRSP deduction (see Schedule 7, and attach receipts) , eduction for elected split-pension amount (attach Form T1032) 210 Annual union, professional, or like dues (box 44 of all T4 slips, and receipts) Universal Child Care Benefit repayment (box 12 of all RC62 slips) 213 Child care expenses (attach Form T778) 214 isability supports deduction 215 Business investment loss ross 228 Allowable deduction 217 Moving expenses 219 Support payments made Total 230 Allowable deduction 220 Carrying charges and interest expenses (attach Schedule 4) 221 eduction 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: 232 Add lines 207 to 224, 229, 231, and 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 Line 235 in the guide). 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 Line 236 in the guide. This is your net income. 236 Taxable income See schedule OTHE , , Canadian Forces personnel and police deduction (box 43 of all T4 slips) 244 Employee home relocation loan deduction (box 37 of all T4 slips) 248 Security options deductions 249 Other payments deduction (if you reported income on line 147, see Line 250 in the guide) 250 Limited partnership losses of other years 251 Non-capital losses of other years 252 Net capital losses of other years 253 Capital gains deduction 254 Northern residents deductions (attach Form T2222) 255 Additional deductions Specify: 256 Add lines 244 to , Line 236 minus line 257 (if negative, enter ''0'') This is your taxable income. 260 Use your taxable income to calculate your federal tax on Schedule 1 and your provincial or territorial tax on Form , , , , R

4 Refund or balance owing FRE JANES SIN: Net federal tax: enter the amount from line 58 of Schedule 1 (attach Schedule 1, even if the result is ''0'') 420 CPP contributions payable on self-employment and other earnings (attach Schedule 8) 421 Employment Insurance premiums payable on self-employment and other eligible earnings (attach Schedule 13) 430 Social benefits repayment (amount from line 235) 422 Provincial or territorial tax (attach Form 428, even if the result is ''0'') 428 Add lines 420, 421, 430, 422, and 428. This is your total payable. 435 Total income tax deducted 437 Refundable Quebec abatement 440 CPP overpayment (enter your excess contributions) 448 Employment Insurance overpayment (enter your excess contributions) Refundable medical expense supplement (use the federal worksheet) 452 Working Income Tax Benefit (WITB) (attach Schedule 6) 453 Refund of investment tax credit (attach Form T2038 (IN)) 454 Part XII.2 trust tax credit (box 38 of all T3 slips) 456 Employee and partner ST/HST rebate (attach Form ST370) 457 Tax paid by instalments 476 Provincial or territorial credits (attach Form 479 if it applies) 479 Add lines 437 to 479. These are your total credits. 482 Line 435 minus line 482 M This is your refund or balance owing. 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. enerally, we do not charge or refund a difference of $2 or less. Refund 484 <NIL> Balance owing 485 7, Amount enclosed Attach to page 1 a cheque, money order, or bank draft payable to the Receiver eneral, or make your payment online (go to Your payment is due no later than April 30, irect deposit - Start or change (see Line 484 in the guide) You do not have to complete this area every year. o not complete it this year if your direct deposit information has not changed. Income tax refund, ST/HST credit, WITB advance payments, and any other deemed overpayment of tax - To start direct deposit or to change account information, complete lines 460, 461, and 462 below. 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 (5 digits) (3 digits) (maximum 12 digits) 12, , , , , , , 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 Telephone It is a serious offence to make a false return. ate 490 For professional tax preparers only Name: Address: TAX SHELTER P.O. BOX 3006 PARAISE NL A1L 3W2 Telephone: (709) o not use this area 5000-R RC Privacy Act, Personal Information Bank number CRA PPU 005

5 FRE JANES /08/13 T Federal Tax Schedule 1 Complete this schedule, and attach a copy to your return. For more information, see the related line in the guide. Step 1 - Federal non-refundable tax credits Basic personal amount claim $10, , Age amount (if you were born in 1946 or earlier) (use federal worksheet) (maximum $6,537) Spouse or common-law partner amount (if negative, enter ''0'') $10,527 minus ( his or her net income from page 1 of your return) = Amount for an eligible dependant (attach Schedule 5) (if negative, enter ''0'') $10,527 minus ( his or her net income) = Amount for children born in 1994 or later Number of children 366 x $2,131 = Amount for infirm dependants age 18 or older (use the federal worksheet and attach Schedule 5) CPP or QPP contributions: through employment from box 16 and box 17 on all T4 slips (maximum $2,217.60) 308 1, on self-employment and other earnings (attach Schedule 8) Employment Insurance premiums: through employment from box 18 and box 55 on all T4 slips (maximum $786.76) on self-employment and other eligible earnings (attach Schedule 13) Volunteer firefighters' amount Canada employment amount (If you reported employment income on line 101 or line 104, see Line 363 in the guide) (maximum $1,065) Public transit amount Children's fitness amount Children's arts amount Home buyers' amount Adoption expenses Pension income amount (use the federal worksheet) (maximum $2,000) 314 2, Caregiver amount (use the federal worksheet and attach Schedule 5) isability amount (for self) (Claim $7,341 or, if you were under 18 years of age, use the federal worksheet) isability amount transferred from a dependant (use the federal worksheet) Interest paid on your student loans Your 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 1994 or later 330 Minus: $2,052 or 3% of line 236, whichever is less Subtotal (if negative, enter ''0'') Allowable amount of medical expenses for other dependants 2, (do the calculation at line 331 in the guide and attach Schedule 5) 331 B Add lines A and B Add lines 1 to , Federal non-refundable tax credit rate 15% 28 Multiply line 27 by line , onations and gifts (attach Schedule 9) Add lines 29 and 30. Enter this amount on line 43 on the next page. Total federal non-refundable tax credits A 1, , o to Step 2 on the next page. Page 1 of S1

6 FRE JANES /08/13 Step 2 - Federal tax on taxable income Enter your taxable income from line 260 of your return. 32 Complete the appropriate column Line 32 is more Line 32 is more depending on the amount on line 32 than $41,544 but than $83,088 but Line 32 is not more than not more than Line 32 is more $41,544 or less $83,088 $128,800 than $128,800 Enter the amount from line Line 33 minus line 34 (cannot be negative) = 32, x % % % % 36 Multiply line 35 by line 36. = Add lines 37 and Step 3 - Net federal tax o to Step 3. o to Step 3. o to Step 3. o to Step 3. Enter the amount from line 39 above. 40 Federal tax on split income (from line 5 of Form T1206) Add lines 40 and Enter your total federal non-refundable tax credits from line 31 of the previous page , Federal dividend tax credit Overseas employment tax credit (attach Form T626) Minimum tax carryover (attach Form T691) Add lines 43 to Line 42 minus line 47 (if negative, enter ''0''). Basic federal tax Federal foreign tax credit (attach Form T2209) Line 48 minus line 49 (if negative, enter ''0''). Federal tax Total federal political contributions (attach receipts) 409 Federal political contribution tax credit (use the federal worksheet) (maximum $650) Investment tax credit (attach Form T2038(IN)) , , , , , , , , , , , , , , , , , Labour-sponsored funds tax credit Net cost 413 Allowable credit Add lines 51, 52, and Line 50 minus line 54 (if negative, enter ''0''). If you have an amount on line 41 above, see Form T , Working Income Tax Benefit advance payments received (box 10 on the RC210 slip) Additional tax on Registered Education Savings Plan accumulated income payments (attach Form T1172) Add lines 55, 56, and 57. Enter this amount on line 420 of your return. Net federal tax , Page 2 of S1 Privacy Act, Personal Information Bank number CRA PPU 005

7 FRE JANES /08/13 T 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 Taxable amount of dividends other than eligible dividends (specify): Enter this amount on line 180 of your return. 180 Taxable amount of eligible dividends (specify): T5 - CIBC Enter this amount on line 120 of your return II - Interest and other investment income Specify: T5 - BANK OF MONTREAL T5 - CIBC Income from foreign sources (specify): T5 - CIBC Enter this amount on line 121 of your return III - Net partnership income (loss) Partnership income shown on T5013 or T5013A Partnership income - certified films and videotapes Resource Income Enter this amount on line 122 of your return. 122 <NIL> IV - Carrying charges and interest expenses Carrying charges (specify): Carrying charges shown on T5013 or T5013A slips, box 59 ividend rental arrangement compensation payments shown on T5013 or T5013A slips, box 57 Interest expenses (specify): Interest on money borrowed to earn other investment income 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 <NIL> 5000-S4 Privacy Act, Personal Information Bank number CRA PPU 005

8 FRE JANES /08/13 T RRSP Unused Contributions, Schedule 7 Transfers, and HBP or LLP Activities enerally, Saskatchewan Pension Plan (SPP) contributions are subject to the same rules as RRSP contributions. For more information about the SPP, visit Complete this schedule, and attach it to your return only when one or more of the following situations applies: You will not be deducting on your return for 2011 all of the unused RRSP contributions, amount (B) of "Your 2011 RRSP eduction Limit Statement" shown on your latest notice of assessment, notice of reassessment, or T1028, Your RRSP Information for You will not be deducting on your return for 2011 all of the RRSP contributions you made from March 2, 2011, to February 29, You have transferred to your RRSP certain amounts you included in your income. You are designating contributions made to your RRSP as a 2011 repayment under the Home Buyers' Plan (HBP) or the Lifelong Learning Plan (LLP). You withdrew funds from your RRSP in 2011 under the HBP or the LLP. (You cannot withdraw funds from your SPP under the HBP or the LLP.) If none of these situations apply to you, do not complete this schedule, and only enter your total RRSP contributions on line 208 of your return. For more information, see Line 208 in the guide. PART A - Contributions Unused RRSP contributions: amount (B) of "Your 2011 RRSP eduction Limit Statement" shown on your latest notice of assessment, notice of reassessment, or T1028, Your RRSP Information for Total contributions* made to your RRSP or your spouse's or common-law partner's RRSP from: March 2, 2011, to ecember 31, 2011 (attach all receipts) 2 January 1, 2012, to February 29, 2012 (attach all receipts) 3 Add lines 2 and Add lines 1 and 4. Total RRSP contributions 5 * Include your transfers and contributions that you are designating as a repayment under the HBP or the LLP. See Line 208 in the guide for the list of contributions to exclude. PART B - Repayments under the HBP and the LLP Specify the contributions made to your RRSP from January 1, 2011, to February 29, 2012, that you are designating as your repayments under the HBP and the LLP for o not include an amount you deducted or designated as a repayment on your 2010 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 Repayment under the LLP Add lines 6 and 7. 8 PART C - RRSP deduction Line 5 minus line 8 RRSP contributions available to deduct 9 RRSP contributions you are deducting for 2011 (this amount cannot exceed the lesser of the amount on line 9, excluding transfers, and your RRSP deduction limit for 2011, shown at amount (A) of "Your 2011 RRSP eduction Limit Statement" on your latest notice of assessment, notice of reassessment, or T1028, Your RRSP Information for 2011) 10 Transfers (see ''Line 11 - Transfers'' at Line 208 in the guide) Add lines 10 and Enter the amount from line 9 or line 12, whichever is less. Also enter this amount on line 208 of your return RRSP deduction PART - RRSP unused contributions available to carry forward Line 9 minus line 13 Your unused RRSP contributions available to carry forward to a future year 14 We will show the amount of line 14 as amount (B) of ''Your 2012 RRSP eduction Limit Statement'' on your 2011 notice of assessment. PART E withdrawals under the HBP and the LLP HBP: enter the amount from box 27 of all your 2011 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 LLP: enter the amount from box 25 of all your 2011 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 , , , , , , , , S7 Privacy Act, Personal Information Bank number CRA PPU 005

9 FRE JANES /08/13 T CPP Contributions Schedule 8 on Self-Employment and Other Earnings For more information, see Line 222 in the guide. Complete this schedule to determine the amount of your Canada Pension Plan (CPP) contributions if: you reported self-employment income on lines 135 to 143 of your return; you reported business or professional income from a partnership on line 122 of your return; or you made an election on Form CPT20 to pay additional CPP contributions on other earnings. Attach a copy of this schedule to your return. Pensionable net self-employment earnings (amounts from line 122 and lines 135 to 143 of your return) 1 Employment earnings not shown on a T4 slip on which you elect to pay additional CPP contributions (attach Form CPT20) Add lines 1 and 2 (if negative, enter ''0''). 3 Enter the amount from box 26 (or if blank, box 14) on all T4 slips (this amount already includes the amount entered on line 11 of Form CPT20, if it applies). 4 Add lines 3 and 4. Total pensionable earnings 5 Basic exemption 6 Earnings subject to contribution Line 5 minus line 6 (if negative, enter ''0'') (maximum $44,800) 7 Multiply the amount on line 7 by 9.9%. 8 Contributions through employment (from box 16 and box 17 of all T4 slips) x 2 = 9 CPP contributions payable on self-employment and other earnings: Line 8 minus line 9 (if negative, enter ''0''). Enter this amount on line 421 of your return. 10 eduction and tax credit for CPP contributions on self-employment and other earnings: 47, , , , , , , Amount from line 10 x 50% = 11 Enter the amount from line 11 on both line 222 of your return and line 310 of Schedule S8 Privacy Act, Personal Information Bank number CRA PPU 005

10 FRE JANES /08/13 T onations and ifts Schedule 9 For more information, see Line 349 in the guide and read Pamphlet P113, ifts and Income Tax. 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. onations made to registered charities, registered Canadian amateur athletic associations, and Canadian low-cost housing corporations for the aged. 1 onations made to government entities (overnment of Canada, provinces or territories, municipal or public bodies performing a function of government in Canada). 2 onations made to prescribed universities outside Canada onations made to the United Nations, its agencies, and certain charitable organizations outside Canada Add lines 1 to 4 Total eligible amount of charitable donations and government gifts 5 Enter your net income from line 236 of your return. x 75% = 6 Note: If the amount on line 5 is less than the amount on line 6, enter the amount from line 5 on line 340 below, and continue completing the schedule from line 340. ifts of depreciable property (from Chart 2 in Pamphlet P113, ifts and Income Tax) ifts of capital property (from Chart 1 in Pamphlet P113, ifts and Income Tax) , , <NIL> Add lines 7 and 8. x 25% = 9 Enter the total of lines 6 and 9 or the amount on line 236 of your return, whichever is less. Total donations limit 10 56, Allowable charitable donations and government gifts (enter the amount from line 5 or line 10, whichever is less) 340 Eligible amount of cultural and ecological gifts (see Line 349 in the guide) 342 Add lines 340 and Enter $200 or the amount from line 344, whichever is less. 345 x 15% = Line 344 minus line x 29% = Add lines 11 and 12. Enter this amount on line 349 of Schedule 1. onations and gifts S9 Privacy Act, Personal Information Bank number CRA PPU 005

11 FRE JANES /08/13 Newfoundland and Labrador Tax and Credits NL 428 T1 eneral Complete this form, and attach a copy to your return. For more information, see related lines in the forms book. Step 1 - Newfoundland and Labrador non-refundable tax credits Page 1 of C For internal use only Basic personal amount claim $7, Age amount (if born in 1946 or earlier) (use provincial worksheet) (maximum $5,100) Spouse or common-law partner amount Base amount Minus: his or her net income from page 1 of your return Result: (if negative, enter ''0'') (maximum $6,528) Amount for an eligible dependant Base amount Minus: his or her net income from line 236 of his or her return Result: (if negative, enter ''0'') (maximum $6,528) Amount for infirm dependants age 18 or older (use provincial worksheet) CPP or QPP 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) (amount from line 317 of your federal Schedule 1) Volunteer firefighters' amount (amount from line 362 of your federal Schedule 1) (maximum $3,000) Child care amount (amount from line 214 of your return) Adoption expenses Pension income amount (maximum $1,000) Caregiver amount (use provincial worksheet) isability amount (for self) isability amount transferred from a dependant (use provincial worksheet) 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: Amount from line 330 of your federal Schedule Enter $1,740 or 3% of line 236 of your return, whichever is less. 22 Line 21 minus line 22 (if negative, enter ''0'') 23 Allowable amount of medical expenses for other dependants (use provincial worksheet) Add lines 23 and Add lines 1 through 20, and line Newfoundland and Labrador non-refundable tax credit rate % 27 Multiply line 26 by line onations and gifts: 7, , , Amount from line 345 of federal Schedule 9 x % = 29 Amount from line 347 of federal Schedule 9 x % = 30 Add lines 29 and Add lines 28 and 31. Enter this amount on line 44. Newfoundland and Labrador non-refundable tax credits , , , , , o to Step 2 on the next page

12 FRE JANES /08/13 Step 2 - Newfoundland and Labrador tax on taxable income Enter your taxable income from line 260 of your return. 33 Line 33 is more than Complete the appropriate column depending on the Line 33 is $31,904 but not Line 33 is more amount on line 33. $31,904 or less more than $63,807 than $63,807 Enter the amount from line Line 34 minus line 35 (cannot be negative) % 37 Multiply line 36 by line Newfoundland and Labrador Add lines 38 and 39. tax on taxable income o to step 3. o to step 3. o to step 3. Step 3 - Newfoundland and Labrador tax Enter your Newfoundland and Labrador tax on taxable income from line Enter your Newfoundland and Labrador tax on split income from Form T Add lines 41 and Enter your Newfoundland and Labrador non-refundable tax credits from line NL dividend tax credit: Credit calculated for line 6152 on the Provincial Worksheet NL overseas employment tax credit: Amount from line 426 of your federal Schedule 1 x % = NL minimum tax carryover: Amount from line 427 of your federal Schedule 1 x % = Add lines 44 to Line 43 minus line 48 (if negative, enter ''0'') 49 NL additional tax for minimum tax purposes: Amount from line 117 of Form T691 x % = 50 Add lines 49 and Enter the provincial foreign tax credit from Form T Line 51 minus line 52 (if negative, enter ''0'') 53 Political contribution tax credit , , , , , , , , , , , , , Newfoundland and Labrador political contributions made in Credit calculated for line 55 on the Provincial Worksheet (maximum $500) 55 Line 53 minus line 55 (if negative, enter ''0'') 56 Labour-sponsored venture capital tax credit Enter the credit amount from Certificate(s) NL LSVC-1. (read line 55 in the forms book) Line 56 minus line 57 (if negative, enter ''0'') 58 irect equity tax credit Enter the credit amount from Form T Line 58 minus line 59 (if negative, enter ''0'') 60 NL resort property investment tax credit Enter the credit amount from Form T Line 60 minus line 61 (if negative, enter ''0'') 62 Continue on the next page Page 2 of C

13 FRE JANES /08/13 Step 3 - Newfoundland and Labrador tax (continued) Newfoundland and Labrador low-income tax reduction If you had a spouse or common-law partner on ecember 31, 2011, 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 62 on the previous page. 63 Unused low-income tax reduction from your spouse or common-law partner, if applicable Line 63 minus line 64 (if negative, enter ''0'') 65 (If you claimed an amount on line 64, enter "0" on line 82.) Adjusted family income for the calculation of the Newfoundland and Labrador low-income tax reduction Column 1 Column 2 You Your spouse or common-law Partner Enter the net income amount from line 236 of the return Total of the Universal Child Care Benefit (UCCB) repayment (line 213 of the return) and the registered disability savings plan (RSP) income repayment (included on line 232) Add lines 66 and Total of the UCCB income (line 117 of the return) and the RSP income (line 125 of the return) Line 68 minus line 69 (if negative, enter ''0'') Add the amounts on line 70 in column 1 and column 2, if applicable. Enter the result on line 77 below. Adjusted family income 71 Enter the amount from line 65 above. 72 Basic reduction claim $ Reduction for your spouse or common-law partner claim $ Reduction for an eligible dependant claimed on line 5816 claim $ Add lines 73, 74, and 75. (maximum $860) 76 Adjusted family income 75, Enter the amount from line 71 above. 77 If you claimed an amount on lines 74 or 75, enter $27,348; otherwise enter $16, Line 77 minus line 78 (if negative, enter ''0'') 79 Applicable rate % 80 75, , , , , , , Multiply line 79 by line Line 76 minus line 81 Newfoundland and Labrador (if negative, enter ''0'') low-income tax reduction 82 Line 72 minus line 82 (if negative, enter ''0'') Enter the result on line 428 of your return. Newfoundland and Labrador tax 83 Unused low-income tax reduction that can be claimed by your spouse or common-law partner 75, Amount from line Amount from line Line 84 minus line 85 (if negative, enter ''0'') Unused amount 86 Page 3 of C Privacy Act, Personal Information Bank number CRA PPU 005

14 FRE JANES /08/13 Provincial Worksheet 2011 T1 eneral Line Age amount Maximum amount 1 Your net income from line 236 of your return 2 Base amount 3 Line 2 minus line 3 (if negative, enter ''0'') 4 Applicable rate 5 75, , , , , Multiply line 4 by line 5. 6 Line 1 minus line 6 (if negative, enter ''0'') 7 Enter this amount on line 5808 of Form NL428. Line Amount for infirm dependants age 18 or older Base amount 1 ependant's net income (line 236 of his or her return) 2 Line 1 minus line 2 (if negative, enter ''0'') (maximum $2,537) 3 If you claimed this dependant on line 5816, enter the amount claimed. 4 Allowable amount for this dependant: line 3 minus line 4 (if negative, enter ''0'') 5 Base amount 1 ependant's net income (line 236 of his or her return) 2 Line 1 minus line 2 (if negative, enter ''0'') (maximum $2,537) 3 If you claimed this dependant on line 5816, enter the amount claimed. 4 Allowable amount for this dependant: line 3 minus line 4 (if negative, enter ''0'') 5 Enter, on line 5820 of Form NL428, the total amount claimed for all dependants. Line Caregiver amount Base amount 1 ependant's net income (line 236 of his or her return) 2 Line 1 minus line 2 (if negative, enter ''0'') (maximum $2,537) 3 If you claimed this dependant on line 5816, enter the amount claimed. 4 Allowable amount for this dependant: line 3 minus line 4 (if negative, enter ''0'') 5 Enter, on line 5840 of Form NL428, the total amount claimed for all dependants.

15 FRE JANES /08/13 Provincial Worksheet 2011 T1 eneral Line isability amount (for self) (supplement calculation if you were under 18 years of age on ecember 31, 2011) Maximum supplement 1 Total child care and attendant care expenses for you, claimed by you or by another person 2 Base amount 3 Line 2 minus line 3 (if negative, enter ''0'') 4 Line 1 minus line 4 (if negative, enter ''0'') 5 Enter, on line 5844 of Form NL428, $5,391 plus the amount from line 5 (maximum $7,928), unless you are completing this chart to calculate the amount at line , , Line isability amount transferred from a dependant Base amount 1 If the dependant was under 18 years of age on ecember 31, 2011, enter the amount from line 5 of the chart for line 5844 for the dependant. If the dependant was 18 years of age or older, enter ''0''. 2 Add lines 1 and 2. 3 Total of amounts your dependant can claim on lines 5804 to 5840 of his or her Form NL428 4 Add lines 3 and 4. 5 ependant's taxable income (line 260 of his or her return) 6 Allowable amount for this dependant: line 5 minus line 6 (if negative, enter ''0'') Enter, on line 5848 of Form NL428, the amount from line 3 or line 7, whichever is less. 7 Enter on line 5848 the total amount claimed for all disabled dependants. If, at the end of the year, you and your dependant were not residents of the same province or territory, special rules may apply. Call the Canada Revenue Agency to determine the amount you can claim. Line Newfoundland and Labrador dividend tax credit Calculate the amount to enter on line 6152 of Form NL428 by completing one of the following two calculations: If you entered an amount on line 120 but no amount on line 180 of your return, complete the following: Line 120 of your return 1 x % = Enter the amount on line 6152 of Form NL428. If you entered amounts on lines 180 and 120 of your return, complete the following: Line 120 of your return Line 180 of your return 2 x % = 4 Line 1 minus line 2 3 x % = 5 Add lines 4 and 5. 6 Enter the amount on line 6152 of Form NL428.

16 FRE JANES /08/13 Charitable onations for 2011 T1-ON Name of organization Amount paid onations made to registered charities, registered Canadian amateur athletic associations and Canadian low-cost housing corporations for the aged onations made to government entities (overnment of Canada, provinces or territories, municipal or public bodies performing a function of government in Canada) onations made to prescribed universities outside Canada onations made to the United Nations, its agencies and certain charitable organizations outside Canada educted on slips Claim donations deducted on slips made by your spouse Carry-forwards of donations from the last five (5) taxation years per schedule Total charitable donations (transferred to line 5 of Schedule 9) Cultural and ecological gifts on T5013 or T5013A slips Cultural and ecological gifts Total cultural and ecological gifts (transferred to line 342 of Schedule 9) Charitable donations available for carry forward