Community Volunteer Income Tax Program
Volunteer Name: _______________
Number of Returns Completed:______
Drop Off Sheet
2013
T1S60 reviewed and signed? Yes No
Efile confirmation number ____________________________________________
YEARS TO BE FILED
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Do you fit into any of the following situations? If YES, you are NOT eligible to participate in this
program.
__ Capital Gains
__ Farming Income
__ Professional/Business Income
__ Commission Income
__ Pre/Post Bankrupt Return
__ Self-Employed
__ Deceased Returns
__ Rental Income
__ Investment income over $1000
__ Employment Expenses
__Other Complex Returns
__ Single (over $30,000) ___Married/Single parent (over $35,000, plus $2,500 for each dependent)
SOCIAL INSURANCE NUMBER_______________________ MR/MRS/MS________ MALE___FEMALE____
FIRST NAME_______________ LAST NAME_____________________ DATE OF BIRTH Year___________
ADDRESS _____________________________________________
Month __________
Do you fit into any of the following situations? If yes, you are NOT eligible to participate in this program.
_________________________________
____
Day ___________
__ Capital Gains
__ Farming Income
__ Professional/Business Income
_________________
CODE_______________
__ Commission
Income __ Pre/PostPOSTAL
Bankrupt
Return
__ Self-Employed
__ Deceased Returns __ Rental Income
__ Investment income over $1000
TELEPHONE NUMBER HOME___________________________ WORK _____________________________
1. What province did you live in on December 31, 2012? _________________
2. If filing for prior years fill in province you lived in on December 31, 2010_______and 2011________
3. Did you immigrate to Canada in 2012 and if so on what date? Y/M/D ________________
4. Marital Status on December 31, 2012?
Married
Widowed
Common Law
(Please Circle One)
Single
Separated
Divorced
If Married or Common Law please complete
Spouse’s name_______________________
Spouse’s SIN ______________________
Spouse’s date of birth__________________
Spouse’s income for 2012____________
Did marital status change at any time during 2011? What was the date of change? _________
5. Authorization for Elections Canada?
_____Yes
____ No
6. Are you applying for the GSTC?
_____ Yes _____ No
7. Do you claim the Disability Tax Credit for yourself or a dependant?
YES NO
8. Do you have tuition/education amount? Carry forward amounts?
YES NO $____________
9. Do you have childcare, children’s fitness, children’s art class expenses?
YES NO $____________
10. Do you have medical expenses?
11. Do you have charitable donations? Carry forward amounts?
YES NO $____________
YES NO $__________CF $_______
12. Do you have a safety deposit box?
13. Do you have monthly bus pass receipts to claim? Enter Amount.
Please Complete Back pages
YES NO $____________
$ ________________
T4 Slip
Issuer's name
Box 14 (24
& 26)
Income
Box 16
CPP/QPP
Box 18 EI
Box 22
Tax
Deducted
T5007 Slip
Box 10 WCB
Box 44
Dues
Box 46
Donations
Box 20 RPP
Contributions
Box 52
Pension
Adjustment
RC52 Slip
Box 11 Social
Assistance
Box 14 Rate
Box 10 Total
Benefits Paid
Box 19 Gross
Pension Paid
Box 20
Overpayment
Recovered
Box 21 Net
Supplement
Paid
Box 22 Income Tax
Deducted
Box 21 # of
Months Disability
Box 23 # of Months
- Retirement
Box 22 Income
Tax Deducted
Box 13 Onset or
Effective Date
Box 18 Lumpsum Payments
Box 24 Annuities
Box 22 Income
Tax Deducted
T4A(OAS)
Box 18 Taxable
Pension Paid
T4A(P)
Box 20 Taxable
CPP Benefits
T4A
Box 16 Pension
or
Superannuation
T4E
Box 14 Total
Benefits Paid
T4RRIF
Box 22 Income
Tax Deducted
Box 16 Taxable
Amounts
Box 28 Income Tax
Deducted
T4RSP
Box 16 Annuity
Payments
Box 28 Other
Income or
Deductions
Box 30
Income Tax
Deducted
Box 26 Dividend
Tax Credit for
Eligible
Dividends
Box 11 Taxable
Amount of Dividends
Other Than Eligible
Dividends
Box 12 Interest
From Canadian
Sources
Box 50 Taxable
Amt of Eligible
Dividends
Box 51 Dividend Tax
Credit for Eligible
Dividends
Box 21 Capital
Gains
Box 22 Withdrawal
& Comm. Payments
T5
Box 25 Taxable
Amount of
Eligible
Dividends
T3
Box 49 Actual
Amt of Eligible
Dividends
Box 30 Capital
Gains Eligible for
Deduction
Box 23 Québec Income
Tax Deducted
CHILDREN INFORMATION (CHILDREN IN YOUR CARE ONLY)
First Name
Last Name
Date of Birth
Relationship
Net Income
Relationship
Net Income
Y/M/D
ELIGIBLE DEPENDANT INFORMATION
First Name
Last Name
Date of Birth
Y/M/D
RENT OR PROPERTY TAX
Address
Number
Total Rent or
Name of individuals who
Name of landlord or Municipality
of
Property tax
shared accommodations
to whom payment was Made
Months
paid in 2012
with you
2012
Proper Identification provided and verified for security purposes:
YES
NO
__________________________________________________________________
_______________________________________________________________________________
Do you require a summary of your tax return?
Yes
No
Unless requested one will not be provided as you should receive your official Notice of
Assessment from CRA within 2 weeks, some instances where you may need Line 150 are
for applications for different benefits such as Pharmacare, Daycare Subsidy, or Canada
Student Loans.
Please complete and then Sign the Form T1S60. Please note that if the Form is
not completed we will not be able to complete or electronically file your return.
Thank you.