Canada Revenue

Agency
Agence du revenu
du Canada
Protected B when completed

Income Tax and Benefit Return 2019

Before you start:

If you are filling out this return for a deceased person, make sure you enter their information in all the boxes in Step 1.

Step 1 – Identification and other information 7

Identification Information about you
Print your name and address below.
Enter your social
First name and initial insurance number (SIN): 6 2 8 2 3 4 2 7 0
Kristina L Year Month Day
Last name Enter your date of birth: 1 9 6 0 1 2 2 5
Dagenais English Français
Your language of correspondence:
Mailing address: Apt No. – Street No. Street name Votre langue de correspondance :

PO Box RR
Is this return for a deceased person?
370
Ensure the SIN information above is for the deceased
City Prov./Terr. Postal code
person.
Blaine Lake S K S 0 J 0 J 0
If this return is for a Year Month Day
deceased person,
Email address enter the date of death:

By providing an email address, you are registering to receive Marital status

email notifications from the CRA and agree to the Terms of use Tick the box that applies to your marital status on
under Step 1 in the guide. December 31, 2019:

1 Married 2 Living common-law 3 Widowed

Enter an email address: [email protected]
4 Divorced 5 Separated 6 Single

Information about your residence Information about your spouse or

Enter your province or territory of common-law partner (if you ticked box 1 or 2 above)
residence on December 31,
2019: Saskatchewan Enter their SIN: 6 2 2 9 1 9 7 6 9
Enter their first name: Gerald
Enter the province or territory
where you currently reside if it is Enter their net income for 2019
not the same as your mailing 52,163 30
to claim certain credits:
address above:
If you were self-employed in Enter the amount of universal child
2019, enter the province or care benefit (UCCB) from line 11700
territory where your business had of their return:
a permanent establishment: Enter the amount of UCCB
repayment from line 21300 of their
If you became or ceased to be a resident of Canada for return:
income tax purposes in 2019 , enter the date of:
Month Day Month Day Tick this box if they were self-employed in 2019: 1
entry or departure
Do not use this area

Do not use
this area 17200 17100

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 Name: Kristina L Dagenais SIN: 628 234 270

Step 1 – Identification and other information (continued) Protected B when completed

Please answer the following questions.

Elections Canada (For more information, see "Elections Canada" under Step 1, in the guide.)

A) Do you have Canadian citizenship? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes 1 No 2

If yes, go to question B. If no, skip question B.

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 or, if
you are aged 14 to 17, to update the Register of Future Electors? . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes 1 No 2

Your authorization is valid until you file your next tax return. Your information will only be used for purposes permitted under
the Canada Elections Act, which include sharing lists of electors produced from the National Register of Electors with
provincial and territorial electoral agencies, members of Parliament, registered and eligible political parties, and candidates
at election time.

Your information in the Register of Future Electors will be included in the National Register of Electors once you turn 18.
Information from the Register of Future Electors can be shared only with provincial and territorial electoral agencies that are
allowed to collect future elector information. In addition, Elections Canada can use information in the Register of Future
Electors to provide youth with educational information about the electoral process.

Indian Act – Exempt income

Tick this box if you have any income that is exempt under the Indian Act.
For more information on this type of income, go to canada.ca/taxes-aboriginal-peoples. 1

If you tick the box, get and complete Form T90, Income Exempt under the Indian Act. Complete this form so that the CRA
can calculate your Canada training credit limit for the 2020 tax year. The information you provide may also be used to
calculate your Canada workers benefit for the 2019 tax year, if applicable.

Foreign property

Did you own or hold specified foreign property where the total cost amount of all such
property, at any time in 2019, was more than CAN$100,000? . . . . . . . . . . . . . . . . . . . . . . . . . . . 26600 Yes 1 No 2

If yes , get and complete Form T1135, Foreign Income Verification Statement. There are substantial penalties for not
completing and filing Form T1135 by the due date. For more information, see Form T1135.

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 Name: Kristina L Dagenais SIN: 628 234 270
Protected B when completed
Attach only the documents (schedules, information slips, forms, or receipts) requested to support
any claim or deduction. Keep all other supporting documents.
Step 2 – Total income
As a resident of Canada, you have to report your income from all sources both inside and outside Canada.
The Income Tax and Benefit Guide may have additional information for certain lines.
Employment income (box 14 of all T4 slips) 10100 12,000 00
Tax-exempt income for emergency services volunteers
(See line 10100 in the guide.) 10105
Commissions included on line 10100 (box 42 of all T4 slips) 10120
Wage-loss replacement contributions (See line 10100 in the guide.) 10130
Other employment income 10400 +
Old age security pension (box 18 of the T4A(OAS) slip) 11300 +
CPP or QPP benefits (box 20 of the T4A(P) slip) 11400 +
Disability benefits included on line 11400 (box 16 of the T4A(P) slip) 11410
Other pensions and superannuation
(See line 11500 in the guide and complete line 31400 in the Worksheet for the return.) 11500 +
Elected split-pension amount (Get and complete Form T1032.) 11600 +
Universal child care benefit (UCCB) (See the RC62 slip.) 11700 +
UCCB amount designated to a dependant 11701
Employment insurance and other benefits (box 14 of the T4E slip) 11900 +
Employment insurance maternity and parental benefits and provincial
parental insurance plan benefits 11905
Taxable amount of dividends (eligible and other than eligible) from taxable Canadian corporations
(Complete the Worksheet for the return.) 12000 +
Taxable amount of dividends other than eligible dividends, included on
line 12000, from taxable Canadian corporations 12010
Interest and other investment income (Complete the Worksheet for the return.) 12100 +
Net partnership income: limited or non-active partners only 12200 +
Registered disability savings plan income (box 131 of the T4A slip) 12500 +
Rental income Gross 12599 Net 12600 +
Taxable capital gains (Complete Schedule 3.) 12700 +
Support payments received Total 12799 Taxable amount 12800 +
RRSP income (from all T4RSP slips) 12900 +
Other income Specify: 13000 + 6,000 00

Taxable scholarship, fellowships, bursaries, and artists' project grants 13010 +

Self-employment income
Business income Gross 13499 Net 13500 +
Professional income Gross 13699 Net 13700 +
Commission income Gross 13899 Net 13900 +
Farming income Gross 14099 Net 14100 +
Fishing income Gross 14299 Net 14300 +
Workers' compensation benefits (box 10 of the T5007 slip) 14400
Social assistance payments 14500 +
Net federal supplements (box 21 of the T4A(OAS) slip) 14600 +

Add lines 14400, 14500, and 14600. (See line 25000 in Step 4.) = 14700 +
Add lines 10100, 10400 to 11400, 11500 to 11700, 11900, 12000,
12100 to 12500, 12600, 12700, 12800, 12900 to 13010, 13500, 13700,
13900, 14100, 14300, and 14700. This is your total income. 15000 = 18,000 00

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 Name: Kristina L Dagenais SIN: 628 234 270
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Step 3 – Net income
Enter your total income from line 15000 from the previous page. 15000 18,000 00
Pension adjustment (box 52 of all T4 slips and
box 034 of all T4A slips) 20600
Registered pension plan deduction
(box 20 of all T4 slips and box 032 of all T4A slips) 20700
RRSP deduction (See Schedule 7 and attach receipts.) 20800 +
Pooled registered pension plan (PRPP)
employer contributions (amount from your
PRPP contribution receipts) 20810

Deduction for elected split-pension amount (Get and complete Form T1032.) 21000 +

Annual union, professional, or like dues (receipts and box 44 of all T4 slips) 21200 +

Universal child care benefit repayment (box 12 of all RC62 slips) 21300 +
Child care expenses (Get and complete Form T778.) 21400 +

Disability supports deduction (Get and complete Form T929.) 21500 +

Business investment loss Gross 21699 Allowable deduction 21700 +

Moving expenses (Get and complete Form T1-M.) 21900 +
Support payments made Total 21999 Allowable deduction 22000 +
Carrying charges and interest expenses
(Complete the Worksheet for the return.) 22100 +
Deduction for CPP or QPP contributions on self-employment and other
earnings (Complete Schedule 8 or get and complete Form RC381,
whichever applies.) 22200 + •

Deduction for CPP or QPP enhanced contributions on employment income

(Complete Schedule 8 or get and complete Form RC381, whichever applies.) 22215 + 12 75 •

Exploration and development expenses (Get and complete Form T1229.) 22400 +
Other employment expenses 22900 +

Clergy residence deduction (Get and complete Form T1223.) 23100 +

Other deductions Specify: 23200 +
Add lines 20700, 20800, 21000 to 21500, 21700, 21900, 22000, and
22100 to 23200. 23300 = 12 75 – 12 75

Line 15000 minus line 23300 (if negative, enter "0") This is your net income before adjustments. 23400 = 17,987 25 •

Social benefits repayment (If you reported income at line 11900 and the amount at line 23400 is
greater than $66,375, see the repayment chart on the back of your T4E slip. If you reported income
on lines 11300 or 14600, and the amount at line 23400 is greater than $77,580, complete the chart
for line 23500 on the Worksheet for the return. Otherwise, enter "0".) 23500 –
Line 23400 minus line 23500 (if negative, enter "0") This is your net income. 23600 = 17,987 25

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 Name: Kristina L Dagenais SIN: 628 234 270
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Step 4 – Taxable income

Canadian Forces personnel and police deduction (box 43 of all T4 slips) 24400
Security options deductions 24900 +

Other payments deduction (Claim the amount from line 14700, unless it
includes an amount at line 14600. If so, see line 25000 in the guide.) 25000 +
Limited partnership losses of other years 25100 +
Non-capital losses of other years 25200 +
Net capital losses of other years 25300 +
Capital gains deduction (Get and complete Form T657.) 25400 +

Northern residents deductions (Get and complete Form T2222.) 25500 +

Additional deductions Specify: 25600 +
Add lines 24400 to 25600. 25700 = –
Line 23600 minus line 25700 (if negative, enter "0") This is your taxable income. 26000 = 17,987 25

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Step 5 – Federal tax (formerly Schedule 1) Protected B when completed

Part A – Federal non-refundable tax credits

Basic personal amount claim $12,069 30000 12,069 00 1
Age amount (if you were born in 1954 or earlier)
(Complete the Worksheet for the return.) (maximum $7,494) 30100 + 2
Spouse or common-law partner amount (Complete Schedule 5.) 30300 + 3
Amount for an eligible dependant (Complete Schedule 5.) 30400 + 4
Canada caregiver amount for spouse or common-law partner, or eligible dependant
age 18 or older (Complete Schedule 5.) 30425 + 5

Canada caregiver amount for other infirm dependants age 18 or older (Complete Schedule 5.) 30450 + 6
Canada caregiver amount for infirm children under 18 years of age
Enter the number of children for whom you are claiming this amount. 30499 × $ 2,230 = 30500 + 7
Base CPP or QPP contributions:
through employment income
(Complete Schedule 8 or get and complete Form RC381, whichever applies.) 30800 + 420 75 • 8
on self-employment and other earnings
(Complete Schedule 8 or get and complete Form RC381, whichever applies.) 31000 + • 9
Employment insurance premiums:
through employment from box 18 and box 55 of all T4 slips (maximum $860.22) 31200 + • 10

on self-employment and other eligible earnings (Complete Schedule 13.) 31217 + • 11

Volunteer firefighters' amount 31220 + 12
Search and rescue volunteers' amount 31240 + 13
Canada employment amount (Enter $1,222 or the total of your employment income you reported
on lines 10100 and 10400, whichever is less .) 31260 + 1,222 00 14
Home buyers' amount 31270 + 15

Home accessibility expenses (Complete the Worksheet for the return.) (maximum $10,000) 31285 + 16
Adoption expenses 31300 + 17

Pension income amount (Complete the Worksheet for the return. ) (maximum $2,000) 31400 + 18
Disability amount (for self)
(Claim $8,416 or if you were under 18 years of age, complete the Worksheet for the return.) 31600 + 19

Disability amount transferred from a dependant (Complete the Worksheet for the return.) 31800 + 20
Interest paid on your student loans (See Guide P105.) 31900 + 21
Your tuition, education, and textbook amounts (Complete Schedule 11.) 32300 + 22
Tuition amount transferred from a child 32400 + 23
Amounts transferred from your spouse or common-law partner (CompleteSchedule 2.) 32600 + 24
Medical expenses for self, spouse or common-law partner, and
your dependent children born in 2002 or later 33099 8,479 58 25
Enter $2,352 or 3% of line 23600, whichever is less. – 539 62 26
Line 25 minus line 26 (if negative, enter "0") = 7,939 96 27
Allowable amount of medical expenses for other dependants
(Complete the Worksheet for the return.) 33199 + 28
Add lines 27 and 28. = 7,939 96 33200 + 7,939 96 29
Add lines 1 to 24, and line 29. 33500 = 21,651 71 30
Federal non-refundable tax credit rate × 15% 31
Multiply line 30 by line 31. 33800 = 3,247 76 32
Donations and gifts (Complete Schedule 9.) 34900 + 3 00 33
Add lines 32 and 33.
Enter this amount on line 46 on the next page. Total federal non-refundable tax credits 35000 = 3,250 76 34

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 Name: Kristina L Dagenais SIN: 628 234 270
Protected B when completed
Part B – Federal tax on taxable income
Enter your taxable income from line 26000. 17,987 25 35
Complete the
appropriate column Line 35 is more Line 35 is more Line 35 is more
depending on the Line 35 is than $47,630 but than $95,259 but than $147,667 but Line 35 is more
amount on line 35. $47,630 or less not more than not more than not more than than $210,371
$95,259 $147,667 $210,371
Enter the amount
from line 35. 17,987 25 36
Line 36 minus line 37 – 0 00 – 47,630 00 – 95,259 00 – 147,667 00 – 210,371 00 37
(cannot be negative) = 17,987 25 = = = = 38
Multiply line 38 × 15% × 20.5% × 26% × 29% × 33% 39
by line 39. = 2,698 09 = = = = 40
+ 0 00 + 7,145 00 + 16,908 00 + 30,535 00 + 48,719 00 41

Add lines 40 and 41. = 2,698 09 = = = = 42

Part C – Net federal tax

Enter the amount from line 42. 2,698 09 43

Federal tax on split income (Get and complete Form T1206.) 40424 + • 44
Add lines 43 and 44. 40400 = 2,698 09 2,698 09 45
Enter your total federal non-refundable tax credits
from line 34 on the previous page. 35000 3,250 76 46
Federal dividend tax credit (See line 40425 in the guide.) 40425 + • 47
Minimum tax carryover (Get and complete Form T691.) 40427 + • 48
Add lines 46, 47, and 48. = 3,250 76 – 3,250 76 49

Line 45 minus line 49 (if negative, enter "0") Basic federal tax 42900 = 50
Federal foreign tax credit (Get and complete Form T2209.) 40500 – 51

Line 50 minus line 51 (if negative, enter "0") Federal tax 40600 = 52
Total federal political contributions
( attach receipts) 40900 70 00 53
Federal political contribution tax credit
(Complete the Worksheet for the return.) (maximum $650) 41000 52 50 • 54

Investment tax credit (Get and complete Form T2038(IND).) 41200 + • 55

Labour-sponsored funds tax credit

(See lines 41300 and 41400 in the guide.)
Net cost of shares of a
provincially registered fund 41300 Allowable credit 41400 + • 56
Add lines 54, 55, and 56. 41600 = 52 50 – 52 50 57
Line 52 minus line 57 (if negative, enter "0") 41700 = 58
Canada workers benefit advance payments received
(box 10 of the RC210 slip) 41500 + • 59
Special taxes (See line 41800 in the guide.) 41800 + 60
Add lines 58, 59, and 60.
Enter this amount on line 42000 on the next page. Net federal tax 42000 = 61

Step 6 – Provincial or territorial tax

Complete Form 428 to calculate your provincial tax.

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 Name: Kristina L Dagenais SIN: 628 234 270
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Step 7 – Refund or balance owing
Net federal tax: enter the amount from line 61 from the previous page. 42000
CPP contributions payable on self-employment and other earnings
(Complete Schedule 8 or get and complete Form RC381, whichever applies.) 42100 +
Employment insurance premiums payable on self-employment and other eligible earnings
(Complete Schedule 13.) 42120 +
Social benefits repayment (amount from line 23500) 42200 +
Provincial or territorial tax (Attach Form 428, even if the result is "0".) 42800 +
Add lines 42000, 42100, 42120, 42200, and 42800. This is your total payable. 43500 = •
Total income tax deducted (amounts from all Canadian slips) 43700 •
Refundable Quebec abatement (See line 44000 in the guide.) 44000 + •
CPP overpayment (See line 30800 in the guide.) 44800 + 0 06 •
Employment insurance overpayment (See line 45000 in the guide.) 45000 + •
Climate Action Incentive (Complete Schedule 14.) 45110 + •
Refundable medical expense supplement
(Complete the Worksheet for the return.) 45200 + •
Canada workers benefit (CWB) (Complete Schedule 6.) 45300 + •

Refund of investment tax credit (Get and complete Form T2038(IND).) 45400 + •

Part XII.2 trust tax credit (box 38 of all T3 slips and box 209 of all T5013 slips) 45600 + •

Employee and partner GST/HST rebate (Get and complete Form GST370.) 45700 + •
Eligible educator school supply tax credit
Supplies expenses (maximum $1,000) 46800 × 15% = 46900 + •
Tax paid by instalments 47600 + •
Provincial or territorial credits (Complete Form 479, if it applies.) 47900 + •
Add lines 43700 to 45700, and 46900
to 47900. These are your total credits. 48200 = 0 06 – 0 06
Line 43500 minus line 48200 This is your refund or balance owing. = -0 06
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 48400 0 06 • Balance owing 48500 •
For more information on how to receive your refund For more information on how to make your payment, see
by direct deposit, see line 48400 in the guide or go line 48500 in the guide or go to canada.ca/payments.
to canada.ca/cra-direct-deposit. Your payment is due no later than April 30, 2020.
I certify that the information given on this return and in any If this return was completed by a tax professional, tick the
documents attached is correct and complete and fully discloses applicable box and provide the following information:
all my income.
Sign here 49000 Was a fee charged? Yes 1 No 2

It is a serious offence to make a false return.

48900 EFILE number (if applicable):
Telephone number: ( 306 ) 466 – 7133 Name of tax professional:
Date: Telephone number: ( ) –

Personal information (including the SIN) is collected for the purposes of the administration or enforcement of the Income Tax Act and related programs and
activities including administering tax, benefits, audit, compliance, and collection. The information collected may be used or disclosed for purposes of other
federal acts that provide for the imposition and collection of a tax or duty. It may also be disclosed to other federal, provincial, territorial or foreign government
institutions to the extent authorized by law. Failure to provide this information may result in interest payable, penalties or other actions. Under the Privacy Act,
individuals have the right to access their personal information, request correction, or file a complaint to the Privacy Commissioner of Canada regarding the
handling of the individual’s personal information. Refer to Personal Information Bank CRA PPU 005 on Info Source at canada.ca/cra-info-source.

Do not use 48700 48800 • 48600 •

this area CRA approval number: RC-19-1113
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T1-2019 Canada Pension Plan
Contributions and Overpayment for 2019 Schedule 8
The Canada Pension Plan (CPP) Act was amended to provide for the enhancement of pensions. The government of Quebec
also adopted legislative amendments to enhance the Quebec Pension Plan (QPP) in a similar way to the federal plan. The
enhancements are funded by additional enhanced contributions beginning in January 2019.
As an employee, your employer will already have deducted the contributions from your salary and wages. The contributions
consist of a base and an enhanced amount. As a self-employed individual, you will calculate your required contributions
(if any) on this schedule, which will include the base and the enhanced amounts.
Complete this schedule and attach it to your return to calculate your required Canada Pension Plan (CPP) contributions or
overpayment for 2019 if you were a resident of a province or territory other than Quebec on December 31, 2019, and have
no earned income from the province of Quebec.
Do not use this schedule if any of your T4 slips have Quebec Pension Plan (QPP) contributions. Instead get and complete
Form RC381, Inter-provincial calculation for CPP and QPP contributions and overpayments for 2019.
Part 1 – Complete this part if you are electing to stop contributing to the CPP or revoking a prior election.
Part 2 – Complete this part to determine the number of months for the CPP contributions calculation.
Part 3 – Complete this part if you are reporting employment income.
Part 4 – Complete this part if you are reporting only self-employment income or other earnings you are electing to pay CPP
contributions on.
Part 5 – Complete this part if you are reporting employment income and self-employment income or other earnings you are
electing to pay CPP contributions on. You must first complete Part 3.
For more information, see lines 22200, 22215, 30800, and 31000 in the guide.

Part 1 – Election to stop contributing to the Canada Pension Plan

or revocation of a prior election
If in 2019 you were 60 to 70 years of age, you received a CPP or QPP retirement pension, and you had employment and/
or self-employment income, you were considered a CPP working beneficiary and you were required to make CPP
contributions. However, if you were at least 65 years of age but under 70, you can elect to stop paying CPP contributions.
If you have employment income for 2019 and elected in 2019 to stop paying CPP contributions or revoked in 2019 an
election made in a prior year, you should have already completed Form CPT30, Election to Stop Contributing to the
Canada Pension Plan, or Revocation of a Prior Election, and sent it to us and your employer(s).
If you had only self-employment income for 2019 and elect in 2019 to stop paying CPP contributions on your
self-employment earnings, enter the month in 2019 for which you choose to start this election in box 50372 below. The
date cannot be earlier than the month you turn 65 and you are receiving a CPP or QPP retirement pension. For example,
if you turn 65 in June, you can choose any month from June to December. If you choose the month of June, enter 06 in
box 50372 because June is the sixth month of the year. If in 2019 you are revoking an election made in a prior year on
contributions on self-employment earnings, enter the month in 2019 for which you choose to revoke this election in box
50374 below. Your election remains valid until you revoke it or you turn 70. If you start receiving employment income
(other than employment income earned in Quebec) in a future year, you will have to complete Form CPT30 in that year for
your election to remain valid.
If you had both employment income and self-employment income in 2019 and wanted to elect to stop paying CPP
contributions in 2019, or to revoke in 2019 an election made in a prior year, you should have completed Form CPT30 in
2019. An election filed using Form CPT30 applies to all income from pensionable earnings, including
self-employment earnings, as of the first day of the month after the date you gave this form to your employer. If you
completed and submitted Form CPT30 when you became employed in 2019 but your intent was to elect in 2019 to stop
paying CPP contributions or revoke an election made in a prior year on your self-employment income before you became
employed, enter the month you want to stop contributing in box 50372 below, or if you want to revoke in 2019 an election
made in a prior year, enter the month you want to resume contributing in box 50374 below. If you did not complete and
submit Form CPT30 for 2019 when you became employed, you cannot elect to stop paying CPP contributions or revoke
an election made in a prior year on your self-employment earnings for 2019 on this schedule.

To be valid, an election or revocation that begins in 2019 must be filed on or before June 15, 2021.
Month
I elect to stop contributing to the Canada Pension Plan on my self-employment earnings on the first 50372
day of the month that I entered in box 50372.
Month
I want to revoke an election made in a prior year to stop contributing to the Canada Pension Plan on 50374
my self-employment earnings and resume contributing on the first day of the month that I entered in
box 50374.
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Protected B when completed

Part 2 – Determine the number of months for the CPP contributions calculation

Enter 12 in box A unless any of the situations below apply:

• if you turned 18 years of age in 2019, enter the number of months in the year after the month you turned 18
• if for all of 2019 you were receiving a CPP or QPP disability pension, enter "0". If you started or stopped receiving a CPP
or QPP disability pension in 2019, enter the number of months during which you were not receiving a disability pension
• if you were 65 to 70 years of age in 2019, you were receiving a CPP or QPP retirement pension, and you elected to stop
paying CPP contributions in 2019, enter the number of months in the year up to and including the month you made the
election. If you had self-employment income in 2019 and have an entry in box 50372 of Part 1, enter the number of
months in the year prior to the month you entered in box 50372 of Part 1

• if you were 65 to 70 years of age in 2019, you were receiving a CPP or QPP retirement pension, you elected to stop
paying CPP contributions in a prior year, and you have not revoked that election, enter "0"
• if you were 65 to 70 years of age in 2019, you were receiving a CPP or QPP retirement pension, you elected to stop
paying CPP contributions in a prior year, and you revoked that election in 2019, enter the number of months in the year
after the month you revoked the election. If you had self-employment income in 2019 and have an entry in box 50374 of
Part 1, enter the number of months in the year after and including the month you entered in box 50374 of Part 1

• if you turned 70 years of age in 2019 and you did not elect to stop paying CPP contributions, enter the number of
months in the year up to and including the month you turned 70 years of age
• if for all of 2019 you were 70 years of age or older, enter "0"
• if the individual died in 2019, enter the number of months in the year up to and including the month the individual died

Enter the number of months during which the CPP applies in 2019. 12 A

Monthly proration table for 2019

Applicable Applicable
Maximum CPP Maximum basic Maximum CPP Maximum basic
number of number of
pensionable earnings CPP exemption * pensionable earnings CPP exemption *
months months
1 $4,783.33 $291.67 7 $33,483.33 $2,041.67
2 $9,566.67 $583.33 8 $38,266.67 $2,333.33
3 $14,350.00 $875.00 9 $43,050.00 $2,625.00
4 $19,133.33 $1,166.67 10 $47,833.33 $2,916.67
5 $23,916.67 $1,458.33 11 $52,616.67 $3,208.33
6 $28,700.00 $1,750.00 12 $57,400.00 $3,500.00

* If you started receiving CPP retirement benefits in 2019, your basic exemption may be prorated by the CRA.

Continue on the next page.

5000-S8
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Part 3 – Calculating your CPP contributions and overpayment on employment income

Enter your yearly maximum CPP pensionable earnings

(see the monthly proration table on the previous page to find the amount
that corresponds to the number of months entered in box A of Part 2). (maximum $57,400) 57,400 00 1
Total CPP pensionable earnings:
Enter the total of box 26 of all your T4 slips (maximum $57,400 per slip).
If box 26 is blank, enter the amount from box 14. 50339 12,000 00 2
Enter the amount from line 1 or the amount from line 2, whichever is less. 12,000 00 3

Enter your maximum basic CPP exemption

(see the monthly proration table on the previous page to find the amount
that corresponds to the number of months entered in box A of Part 2). (maximum $3,500) – 3,500 00 4
Earnings subject to CPP contributions:
Line 3 minus line 4 (if negative, enter "0") (maximum $53,900) = 8,500 00 5
Actual total contributions on CPP pensionable earnings:
Enter the total CPP contributions deducted from box 16 of all your T4 slips. 50340 433 56 •6
Actual base contributions on CPP pensionable earnings:
Multiply the amount from line 6 by 97.0588%. – 420 81 7
Actual enhanced contributions on CPP pensionable earnings:
Line 6 minus line 7 = 12 75 8
Required base contributions on CPP pensionable earnings:
Multiply the amount from line 5 by 4.95%. (maximum $2,668.05) 420 75 9
Required enhanced contributions on CPP pensionable earnings:
Multiply the amount from line 5 by 0.15%. (maximum $80.85) + 12 75 10
Total required contributions on CPP pensionable earnings:
Add lines 9 and 10. – 433 50 11
Line 6 minus line 11 (if negative, enter "0") CPP overpayment = 0 06 12

If you are self-employed or you are electing to pay additional CPP contributions on other earnings, continue with
Part 5. You may be able to make additional CPP contributions if the calculated amount from line 12 is negative.
See Form CPT20, Election To Pay Canada Pension Plan Contributions.

Otherwise, the deduction and tax credit on employment income should be reported as follows:
• Enter the amount, in dollars and cents, from line 7 or line 9, whichever is less , on line 30800 of your return.
If applicable, also enter it on line 58240 of your Form 428.
• Enter the amount from line 8 or line 10, whichever is less , on line 22215 of your return.
• If the amount at line 12 is positive, enter the amount, in dollars and cents, on line 44800 of your return.

5000-S8
Page 3 of 6
 Name: Kristina L Dagenais SIN: 628 234 270

Protected B when completed

Part 4 – CPP contributions on self-employment income and

other earnings ONLY (no employment income)
Pensionable net self-employment earnings *
(amounts from line 12200 and lines 13500 to 14300 of your return) 1
Employment earnings not shown on a T4 slip on which you elect to pay additional
CPP contributions (Get and complete Form CPT20.) 50373 + 2
3
Add lines 1 and 2 (if negative enter "0"). CPP pensionable earnings (maximum $57,400) * =
Basic exemption (maximum $3,500) * – 4
Line 3 minus line 4 (maximum $53,900) = 5
CPP rate × 10.2% 6
Total CPP contributions payable on self-employment and other earnings:
Multiply line 5 by line 6. Enter this amount on line 42100 of your return. = 7

Deduction and tax credit for CPP contributions on self-employment and other earnings

Required base contributions on CPP pensionable earnings:

Multiply the amount from line 7 by 97.0588%. – 8
Required enhanced contributions on CPP pensionable earnings:
Line 7 minus line 8 = 9

Multiply line 8 by 50%. Enter this amount, in dollars and cents, on line 31000 of your return. 10
+
Add lines 9 and 10. Enter this amount on line 22200 of your return. = 11

* Self-employment earnings, CPP pensionable earnings, and the basic exemption should be prorated according to the number of months entered in box
A of Part 2. See the monthly proration table on page two to find the amount that corresponds to the number of months entered in box A of Part 2. Do not
prorate the self-employed earnings if the individual died in 2019.

5000-S8
Page 4 of 6
 Name: Kristina L Dagenais SIN: 628 234 270

Protected B when completed

Part 5 – CPP contributions on self-employment income and other earnings

when you have employment income
Pensionable net self-employment earnings *
(amounts from line 12200 and lines 13500 to 14300 of your return) 1
Employment earnings not shown on a T4 slip on which you elect to pay additional CPP
contributions (Get and complete Form CPT20.) 50373 + 2
Employment earnings shown on a T4 slip on which you elect to pay additional CPP contributions
(Get and complete Form CPT20.) 50399 + 3
Add lines 1, 2, and 3. = 4
Enter the amount from line 6 of Part 3. Actual total CPP contributions 5

If the amount on line 12 of Part 3 is positive, complete lines 6 to 8.

Otherwise, enter "0" on line 8 and continue on line 9.
Enter the amount from line 5 above. 6
Enter the amount from line 11 of Part 3. – 7
Line 6 minus line 7. If negative, do not complete line 8, enter the amount
from line 7 on line 9 and continue on line 10. = – 8
Line 5 minus line 8 (if negative, enter "0") = 9
Multiply the amount from line 9 by 19.60784. = 10

Enter the amount from line 1 of Part 3. CPP pensionable earnings (maximum $57,400) 57,400 00 11
Enter the amount from line 4 of Part 3. Basic exemption (maximum $3,500) – 3,500 00 12
Line 11 minus line 12 (if negative, enter "0") (maximum $53,900) = 13
Enter the amount from line 10. – 14
Line 13 minus line 14 (if negative, enter "0") = 15
Enter the amount from line 4 or line 15, whichever is less. 16
If the amount on line 2 of Part 3 is less than the amount on line 4 of Part 3, complete lines 17 to 19.
Otherwise, enter "0" on line 19 and continue on line 20.

Line 4 of Part 3 minus line 2 of Part 3 17

Line 4 minus line 13 (if negative, enter "0") – 18
Line 17 minus line 18 (if negative, enter "0") = – 19
Earnings subject to contributions:
Line 16 minus line 19 (if negative, enter "0") = 20
Multiply the amount from line 20 by 10.2%. = 21
Multiply the amount from line 12 of Part 3 (if positive only) by 2. – 22
Total CPP contributions payable on self-employment and other earnings:
Line 21 minus line 22 (if negative, enter the amount as a positive amount on line 30 on the next
page and enter "0" on line 23) = 23

* Self-employment earnings should be prorated according to the number of months entered in box A of Part 2.
Do not prorate the self-employment earnings if the individual died in 2019.

Continue on the next page.

5000-S8
Page 5 of 6
 Name: Kristina L Dagenais SIN: 628 234 270

Protected B when completed

Part 5 – CPP contributions on self-employment income and other earnings

when you have employment income (continued)

Deductions and tax credits for CPP contributions

Enter the amount from line 7 of Part 3. 24
Enter the amount from line 9 of Part 3. – 25
Line 24 minus line 25 (if negative enter "0") = 26

Enter the amount, in dollars and cents, from line 24 or line 25, whichever is less , at line 30800 of your return.
Enter the amount from line 8 of Part 3. 27
Enter the amount from line 10 of Part 3. – 28
Line 27 minus line 28 (if negative enter "0") = 29
Enter the amount from line 27 or line 28, whichever is less , at line 22215 of your return.

If the calculated amount at line 23 from the previous page is negative, complete lines 30 to 35 below.

If the calculated amount at line 23 from the previous page is positive, complete lines 36 to 42 below.

Otherwise, if the calculated amount at line 23 on the previous page is zero, enter the amount, in
dollars and cents, from line 26 at line 31000 of your return and the amount from line 29 at line 22200
of your return.
Enter the calculated amount from line 23 from the previous page as a positive amount. = 30
Multiply the amount from line 30 by 50%.
Enter this amount, in dollars and cents, on line 44800 of your return. = 31
Multiply the amount on line 31 by 97.0588%. – 32
Line 31 minus line 32 = 33
Line 26 minus line 32. Enter this amount, in dollars and cents, on line 31000 of your return. = 34
Line 29 minus line 33. Enter this amount on line 22200 of your return. = 35

Enter the amount from line 23 from the previous page.

Enter this amount on line 42100 of your return.
36
Multiply the amount on line 36 by 97.0588%. – 37
Line 36 minus line 37 = 38
Multiply the amount on line 37 by 50%. + 39
Add lines 38 and 39. = 40

Add lines 26 and 39. Enter this amount, in dollars and cents, on line 31000 of your return. = 41
Add lines 29 and 40. Enter this amount on line 22200 of your return. = 42

See the privacy notice on your return.

5000-S8
Page 6 of 6
 Name: Kristina L Dagenais SIN: 628 234 270
Protected B when completed
T1-2019 Donations and Gifts Schedule 9

Complete this schedule and attach it to your return to claim an amount on line 34900 of your return.
For more information, see Pamphlet P113, Gifts and Income Tax.

Eligible amount of charitable donations

Include at lines 1 to 4 all the eligible amounts of donations you want to claim this year. This includes the eligible amount of
donations that either you or your spouse or common-law partner made in 2019 or in any of the previous 5 years that have
not been claimed before. Remember, you may have charitable donations shown on your T4 and T4A slips. If you are
claiming gifts made to a charity in the United States, see Pamphlet P113.
Donations made to registered charities, registered Canadian amateur athletic associations,
and registered Canadian low-cost housing corporations for the aged 20 00 1
Donations made to government bodies (government of Canada, a province, a territory, registered
municipalities in Canada, or registered municipal or public bodies performing a function of
government in Canada) 32900 + 2
Donations made to registered universities outside Canada 33300 + 3
Donations made to the United Nations, its agencies, and certain registered foreign charitable
organizations +
33400 4
Add lines 1 to 4. Total eligible amount of charitable donations = 20 00 5

Donations limit

Enter your net income from line 23600 of your return. 17,987 25 6 × 75% = – 13,490 44 7
If line 5 is less than line 7, enter the amount from line 5 on line 13 below and continue on line 14.
Otherwise, complete lines 8 to 12, before continuing on line 13.

Gifts of depreciable property

(from Chart 2 in Pamphlet P113) 33700 8
Gifts of capital property
(from Chart 1 in Pamphlet P113) 33900 + 9
Add lines 8 and 9. = 10 × 25% = + 11
Enter the total of lines 7 and 11 or the amount on line 23600
of your return, whichever is less. Total donations limit = 12

Donations and gifts

Allowable charitable donations. If you did not complete lines 8 to 12, enter the amount from line 5.
Otherwise, enter the amount from line 5 or line 12, whichever is less. 34000 20 00 13
Eligible amount of cultural and ecological gifts (See Pamphlet P113.) 34200 + 14
Add lines 13 and 14. = 20 00 15
Enter $200 or the amount from line 15, whichever is less. – 20 00 16
Line 15 minus line 16. = 17

Continue on the next page.

5000-S9
Page 1 of 2
 Name: Kristina L Dagenais SIN: 628 234 270
Protected B when completed

If your taxable income is less than $210,371, enter "0" on line 26 and continue on line 28.
Otherwise, complete lines 18 to 27, before continuing on line 28.
Enter the amount from line 17 from the previous page. 18
Total of your donations made before 2016 included on
lines 5 and 14, to a maximum of the amount on line 15
from the previous page. 34210 – 19

Line 18 minus line 19 (if negative, show it in brackets) = 20

Enter the amount from line 16 or line 19,
whichever is less. + 21
Add lines 20 and 21. = 22
Enter your taxable income from line 26000 of
your return. 17,987 25 23
Income threshold – 210,371 00 24

Line 23 minus line 24 (if negative enter "0") = 25

If you did not complete lines 18 to 25, enter "0".

Otherwise, enter the amount from line 22 or line 25,
whichever is less. 26 × 33% = + 27
If you did not complete lines 18 to 27, enter the amount
from line 17. Otherwise, enter the result of line 17
minus line 26. 28 × 29% = + 29
Enter the amount from line 16. 20 00 30 × 15% = + 3 00 31
Add lines 27, 29, and 31.
Enter this amount on line 34900 of your return. Donations and Gifts = 3 00 32

See the privacy notice on your return.

5000-S9

Page 2 of 2
 Name: Kristina L Dagenais SIN: 628 234 270

Form SK428
Saskatchewan Tax and Credits 2019
Protected B when completed

This is Step 6 in completing your return. Complete this form and attach a copy to your return.
Claim only the credits that apply to you.

Part A – Saskatchewan non-refundable tax credits For internal use only 56070
Basic personal amount Claim $16,065 58040 16,065 00 1
Age amount (if born in 1954 or earlier)
(use Worksheet SK428) (maximum $4,894) 58080 + 2
Spouse or common-law partner amount
Base amount 17,672 00 3
Your spouse's or common-law partner's
net income from line 23600 of their return – 52,163 30 4
Line 3 minus line 4 (if negative, enter "0") = (maximum $16,065) 58120 + 5
Amount for an eligible dependant
Base amount 17,672 00 6
Your eligible dependant's net income
from line 23600 of their return – 7
Line 6 minus line 7 (if negative, enter "0") = (maximum $16,065) 58160 + 8
Add lines 1, 2, 5, and 8 = 16,065 00 9
Amount for infirm dependants age 18 or older
(use Worksheet SK428) 58200 + 10
Amount for dependent children born in 2001 or later
(Complete the chart on the last page.) Number of children 58209 × $6,094 = 58210 + 11
Senior supplementary amount (if born in 1954 or earlier) Claim $1,292 58220 + 12
CPP or QPP contributions:
Amount from line 30800 of your return 58240 + 420 75 • 13
Amount from line 31000 of your return 58280 + • 14
Employment insurance premiums:
Amount from line 31200 of your return 58300 + • 15
Amount from line 31217 of your return 58305 + • 16
First-time home buyers' amount (maximum $10,000) 58357 + 17
Pension income amount (maximum $1,000) 58360 + 18
Caregiver amount 19
(use Worksheet SK428) 58400 +
Disability amount (for self)
(Claim $9,464 , or if you were under 18 years of age, use Worksheet SK428.) 58440 + 20
Disability amount transferred from a dependant 21
(use Worksheet SK428) 58480 +
Interest paid on your student loans 22
(amount from line 31900 of your return) 58520 +
Your unused tuition and education amounts 23
( attach Schedule SK(S11)) 58560 +
Amounts transferred from your spouse or common-law partner 24
( attach Schedule SK(S2)) 58640 +
Add lines 9 to 24. = 16,485 75 25

Continue on the next page.

5008-C (Ce formulaire est disponible en français.)

Page 1 of 4
 Name: Kristina L Dagenais SIN: 628 234 270

Protected B when completed

Part A – Saskatchewan non-refundable tax credits (continued)
Amount from line 25 of the previous page 16,485 75 26
Medical expenses:
Amount from line 33099 of your return 58689 8,479 58 27
Enter whichever is less:
$2,268 or 3% of the amount from line 23600 of your return – 539 62 28
Line 27 minus line 28 (if negative, enter "0") = 7,939 96 29
Allowable amount of medical expenses for other dependants
from line 33199 of your return 58729 + 30
Add lines 29 and 30. 58769 = 7,939 96 + 7,939 96 31
Add lines 26 and 31. 58800 = 24,425 71 32
Saskatchewan non-refundable tax credit rate × 10.5% 33
Multiply line 32 by line 33. 58840 = 2,564 70 34
Donations and gifts:
Amount from line 16
of your federal Schedule 9 20 00 × 10.5% = 2 10 35
Amount from line 17
of your federal Schedule 9 × 14.5% = + 36
Add lines 35 and 36. 58969 = 2 10 + 2 10 37
Add lines 34 and 37.
Enter this amount on line 53. Saskatchewan non-refundable tax credits 61500 = 2,566 80 38

Part B – Saskatchewan tax on taxable income

Enter your taxable income from line 26000 of your return. 17,987 25 39

Use the amount from line 39 to decide which column to complete.

Line 39 is
more than $45,225
Line 39 is but not more than Line 39 is
$45,225 or less $129,214 more than $129,214
Amount from line 39 17,987 25 40
– 0.00 – 45,225 00 – 129,214 00 41
Line 40 minus line 41 (cannot be negative) = 17,987 25 = = 42
× 10.5% × 12.5% × 14.5% 43
Multiply line 42 by line 43. = 1,888 66 = = 44
Add lines 44 and 45. + 0.00 + 4,749 00 + 15,247 00 45

Saskatchewan tax on taxable income = 1,888 66 = = 46

Part C – Saskatchewan tax

Enter your Saskatchewan tax on taxable income from line 46. 1,888 66 47

Enter the Saskatchewan farm and small business capital gains tax credit from Form T1237. 61499 – • 48
Line 47 minus line 48 = 1,888 66 49
Enter your Saskatchewan tax on split income from Form T1206. 61510 + • 50
Add lines 49 and 50. = 1,888 66 51

Continue on the next page.

5008-C
Page 2 of 4
 Name: Kristina L Dagenais SIN: 628 234 270

Protected B when completed

Part C – Saskatchewan tax (continued)
Amount from line 51 of the previous page 1,888 66 52

Enter your Saskatchewan non-refundable tax credits from line 38. 2,566 80 53
Saskatchewan dividend tax credit
Credit calculated for line 61520 on Worksheet SK428 61520 + • 54

Saskatchewan minimum tax carryover

Amount from line 40427 of your return × 50% = 61540 + • 55
Add lines 53 to 55. = 2,566 80 – 2,566 80 56
Line 52 minus line 56 (if negative, enter "0") = 57

Saskatchewan additional tax for minimum tax purposes

Form T691: line 111 minus line 114 × 50% = + 58
Add lines 57 and 58. = 59
Enter the provincial foreign tax credit from Form T2036. – 60
Line 59 minus line 60 (if negative, enter "0") = 61

Political contribution tax credit

Saskatchewan political contributions made in 2019 63554 62
Credit calculated for line 63 on Worksheet SK428 (maximum $650) – 63
Line 61 minus line 63 (if negative, enter "0") = 64

Labour-sponsored venture capital tax credit

For investments in venture capital corporations registered in Saskatchewan:
Enter your tax credit from Slip T2C (Sask.). (maximum $875) 65

For investments in venture capital corporations registered federally:

Enter your tax credit from Slip T2C (Sask.). (maximum $875) + 66
Add lines 65 and 66. (maximum $875) 63557 = • – 67
Line 64 minus line 67 (if negative, enter "0") = 68

Saskatchewan mineral exploration tax credit

Saskatchewan mineral exploration tax credit from Slip SK-METC 63600 • 69

Unused Saskatchewan mineral exploration tax credit from

your most recent notice of assessment or reassessment + 70
Add lines 69 and 70. = – 71
Line 68 minus line 71 (if negative, enter "0") = 72

Saskatchewan graduate tuition tax credit

Enter the amount from line 10 of Form RC360, Saskatchewan Graduate Retention Program. 63640 – • 73
Line 72 minus line 73 (if negative, enter "0")
Enter the result on line 42800 of your return. Saskatchewan tax = 74

Continue on the next page.

5008-C
Page 3 of 4
 Name: Kristina L Dagenais SIN: 628 234 270

Protected B when completed

Part C – Saskatchewan tax (continued)

Request for carryback of unused mineral exploration tax credit

Amount from line 71 of the previous page 75
Amount from line 68 of the previous page – 76
Line 75 minus line 76 (if negative, enter "0") = 77
Enter on line 78 any part of the amount from line 77 that you want to carry back to 2018 to reduce
your Saskatchewan tax.
Enter on line 79 any amount that you want to carry back to 2017 and enter on line 80 any amount
that you want to carry back to 2016.
Enter the amount you want to carry back to 2018. 63601 • 78
Enter the amount you want to carry back to 2017. 63602 • 79
Enter the amount you want to carry back to 2016. 63603 • 80

Details of dependent children born in 2001 or later

Relationship to you Date of birth Social insurance number

Child's name
Year Month Day (if available)

If you need more space, attach an additional page.

See the privacy notice on your return.

5008-C
Page 4 of 4
Name: Kristina L Dagenais SIN: 628 234 270
Additional Information
Medical Expenses
Lazer eye surgery (Aug 28, 2019) 8,400.00
Drug Pantoprazole (Feb 4, 2019) 7.88
Drug Pantoprazole (Mar 28, 2019) 7.88
Drug Metrogel (Oct 24, 2019) 21.96
Drug Olopatadine (Oct 24, 2019) 16.88
Drug Premarin (Oct 24, 2019) 9.52
Drug Pantoprazole (Oct 24, 2019) 7.79
Drug Pantoprazole (Dec 3, 2019) 7.67

Donations made to registered charities and other eligible registered associations

Diabetes Canada 20.00

T4 - STATEMENT OF REMUNERATION PAID

T4[1]
Employer name - LAZY DIAMOND FARMS LTD
Employment income 14 12,000.00
Employee's CPP contributions 16 433.56
CPP-QPP pensionable earnings 26 12,000.00
Exempt EI: set to yes if your paper T4 contains X at this box 28 X

T4A - STATEMENT OF PENSION, RETIREMENT, ANNUITY, AND OTHER INCOME

T4A[1]
Additional information - Payer's name: CO-OPERATIVE SUPERANNUATI
Variable pension benefits 133 6,000.00

See the privacy notice on your return.