Tax Preparation Application Form

I (the applicant), herby permit Canadian Support Services Inc. to advise and assist with regard to preparing and filing an individual / family T1 personal income tax return to the Canada Revenue Agency (CRA).

This agreement will serve as confirmation and acceptance upon completion and submission, based on the following terms:

Canadian Support Services Inc. is hereby authorized on behalf of the applicant to act as the primary party in matters related to preparing and filing a T1 personal income tax return, based on the information provided within this application. Any and all T1 income tax returns submitted by, prepared by, and or filed by Canadian Support Services on the applicants behalf may be subject to audit or reassessment at any time by the Canada Revenue Agency. If an audit or reassessment occurs, it is the applicant’s sole responsibility to provide supporting documentation to the Canada Revenue Agency, if requested.

The applicant acknowledges that Canadian Support Services specializes in disability related credits, subsidies, deduction, and benefits available to disabled Canadians. The applicant also acknowledges that a deficit of funds may be the outcome of filing a T1 income tax return, based on the applicants own income, taxes paid, expenses, and available credit or credits, and or taxes owed on any prior or current year.

The applicant will provide copies of all available receipts and documentation necessary for Canadian Support Services to conduct a T1 income tax return. Canadian Support Services is not lawfully responsible for any receipts and or documentation submitted to its offices, either physically or digitally (assumed copies).

For each calendar year Canadian Support Services prepares and files a T1 tax return for an applicant, CSS will retain its acting right to collect a fee starting at $59.99* (+ applicable sales tax) upon checkout and submission of this application. The applicant also agrees to pay an additional $34.99 per additional schedule that requires preparation and or filing (ie. rental income, independent contractor amounts, etc.) The applicant agrees to submit payment to CSS prior to proceeding with preparation and filing services. If for any reason or reasons the applicant fails to comply with or adhere to the provisional instructions within this application, the breach or default of these previsions will result in a hold or termination of the application herein.

Furthermore, the applicant acknowledges that the prepared file will be efiled by Canadian Support Services Inc. once a correctly completed copy of a T183 or T183e has been received. This agreement is governed under the Federal Income Tax Act, and will be tried under the jurisdiction of the applicant’s provincial court of residency regarding any dispute(s) subsequent to this agreement.

APPLICANT INFORMATION

* Please fill in the blank fields below. All information submitted to and collected by Canadian Support Services Inc. will be kept confidential, and will only be divulged if and when necessary to the process of appeasing the applicants desired resolve of preparing and filing the applicants T1 personal tax return. Canadian Support Services Inc. adheres to the federal Privacy Act of Canada as well as the Personal Information Protection and Electronic Documents Act (PIPEDA).

Title*

First Name:*

Last Name:*

Date of Birth (DOB):*

Date

eMail Address:*

Phone Number:*

Unit # / Street # / Street Name:*

City, Province or Territory:*

Postal Code:*

Applicants Social Insurance Number:*

Applicants Status:*

Applicants Canadian Residency Status:*

Canadian citizenPermanent residentFirst nationsRefugee

Applicant Parental / Guardianship Status:*

No dependentsDependent(s)Elderly DependentsPower of Attorney

Would you like the Canada Revenue Agency to provide information for elections Canada?*

YesNo

Which year(s) will the applicant require prepared*

201720162015Other

SPOUSAL INFORMATION

* A spouse is a partner in a marriage, civil union, domestic partnership or common-law relationship. The term is gender neutral, whereas a male spouse is a husband and a female spouse is a wife. Therefore the term may be used in both opposite-sex relationships and same-sex relationships. Although a spouse is a form of significant other, the latter term also includes non-marital partners who play a social role similar to that of a spouse, but do not have rights and duties deserved by law to a spouse. Please note that if the spouse intends to have their personal income tax filed through CSS they must fill in a separate tax application.

Title

First Name:

Last Name:

Date of Birth (DOB):

Date

eMail Address:

Phone Number:

Unit # / Street # / Street Name:

City, Province or Territory:

Postal Code:

Spouse" Social Insurance Number:

Spouse" Residency Status:

Canadian citizenPermanent residentFirst nationsRefugee

Would you like the Canada Revenue Agency to provide information for elections Canada?

YesNo

DEPENDENT INFORMATION

* A dependant is a person who relies on another as a primary source of income or support. For example, a minor child, under the age of majority (18), is a dependant of his or her parent and the existence of the dependant may enable the provider, such as a parent or guardian, to claim a deduction (Ie. UCCB, CBB, etc.). If the applicant has more then 3 children in there care, please add their information in the "notes" section of this application below.

Full Name (Dependent 1):

Social Insurance Number (Dependent 1):

Date of Birth (Dependent 1):

Date

Relation to Applicant (Dependent 1)

Does the dependent live with a severe physical or mental impairment that effects their quality of life?

YesNo

Full Name (Dependent 2):

Social Insurance Number (Dependent 2):

Date of Birth (Dependent 2):

Date

Relation to Applicant (Dependent 2)

Does the dependent live with a severe physical or mental impairment that effects their quality of life?

YesNo

Full Name (Dependent 3):

Social Insurance Number (Dependent 3):

Date of Birth (Dependent 3):

Date

Relation to Applicant (Dependent 3)

Does the dependent live with a severe physical or mental impairment that effects their quality of life?

YesNo

DOCUMENTATION & RECEIPT CHECKLIST

* The applicant must submit any and all information related to this application in order for a correct tax return to be prepared and filed. Please use the checklist below to make sure the applicant has collected all the necessary documentation and receipts required. Canadian Support Services is not lawfully responsible for any receipts and or documentation submitted to its offices, either physically or digitally (assumed copies).

Employment / Other Income- Income slips (T4, T4A, T4E, T4RSP, T4RIF, T3, T5, T5013, RC62)- Stock options / benefit plan statements from employer Investment Information- Annual mutual fund statement for all funds held outside RRSP or RRIF- Details of all investment disposals including information to support original purchase price- Details of investments that were subject to 1994 capital gains election, if any Rental Income- Full address, number of rental units- Revenue and expenses, including mortgage interest- percentage of personal usage, if applicable Self-Employment Income- Revenue for the year (on an accrual basis)- GST, PST, and or HST returns Employment / Self-Employment Expenses- T2200: Conditions of employment form signed by employer- Meals and entertainment - Travel, promotion, conferences, dues, telecommunications, office supplies, etc.- Automotive Receipts- Home office: % used for business, mortgage interest, rent, property tax, utilities, & insurance Deductions- RRSP receipts, including labour sponsored fund credit slips- Child care, with supporting receipts and SIN # of care giver- Safety deposit box rental- Property taxes- Union dues- Moving expenses (up to $2000 if over 40km from old address, if disabled)- Alimony / support payments, with copy of agreement if not previously provided- Accounting fees, investment counsel fee- Legal fees to collect salary, alimony, lost or stollen funds- Investment / business interest expense- Tax shelter deductions - require tax slip and tax reporting package- Tools (trades person)- Rent (require landlords name & contact information, # of months, and address if no current) Tax Credits- Charitable and or political donation receipts- Medical / dental / attendance care expenses with receipts- Tuition fee and books receipts- Disability credit form (T2201) for self or dependents for first time claims- Student loan interest statement- Child fitness receipts for children under the age 16- Child art program receipts for children under the age 16- Receipts for monthly transit pass or passes- Volunteer firefighter documentation- Indicate if eligible for first-time home buyers credit for current year

Please attach any copies of documents and or receipts from the list provided above.

Select File

*Note: If the applicant is unable to scan and send copies or receipts and documents, the applicant must submit copies of any and all receipts or documentation to Canadian Support Services via fax (1.888.937.2770) or by mail to our head office. Canadian Support Services Tax Department100 King Street West, Suite # 5700Toronto, OntarioM5X 1C7

Please provide notes or comments relating to the applicants T1 tax application request in the area provided (ex. additional dependents, Self employment information, etc.).

I (the applicant) have read, understand, and acknowledge the agreement stated herein, and declare that all the information I have provided in this application is true.*

Yes