2 - U.S. 1040 Supplemental Checklist -Schedule A

U.S. 1040 Supplemental Checklist -Schedule A

Complete this schedule ONLY if you were a US citizen, Green Card holder or you spent over 182 days in the US during the year . (One Form per Year)
Name*

PrefixFirst NameMiddle NameLast NameSuffix
Tax Year*

20232022202120202019Other
Did you transfer, gift or receive property to/from another individual, trust, estate, partnership or corporation? If YES, provide details below.
Indicate entities in which you have direct or indirect interest (other than inside an RRSP/RPP/IRA/40lK/403(b), etc), irrespective of the type or % of interest/shares owned:

Non-US Private CorporationNon-US Partnership or Limited Liability CompanyNon-US Trust (including RESP, RDSP or TFSA)Non-US Mutual Fund/Segregated Fund/Exchange Traded FundOther
(FOREIGN BANK AND FINANCIAL REPORTING — ‘FBAR’) FinCEN 114
Did you, at any time during the year, have ownership of or signing authority over any non-US personal or business bank or ﬁnancial accounts (including personal, Trust or corporate checking, savings, securities, RRSP, TFSA, RESP, RDSP, life insurance with a cash surrender value, etc)? with an Aggregate Value in Excess of USD 10,000.00*

YES - Provide details on Schedule "C", Section 1NO
SPECIFIED FOREIGN FINANCIAL ASSET REPORTING (Form 8938)

(These include All non-US ﬁnancial accounts, including non-US pension plans and non-US equity compensation plans.)
Aggregate Reporting Thresholds based on the Aggregate Value of all of your non-US Depending on Filing Status & Country of Residency
Unmarried or Married Filing Separately - US Resident

> USD 50,000.00 on the Last Day of the Year> USD 75,000.00 at any Time during the Year
Married Filing Jointly - US Resident

> USD 100,000.00 on the Last Day of the Year> USD 150,000.00 at any Time during the Year
Unmarried or Married Filing Separately - Foreign Resident

USD 200,000.00 on the Last Day of the YearUSD 300,000.00 at any Time during the Year
Married Filing Jointly - Foreign Resident

USD 400,000.00 on the Last Day of the YearUSD 600,000.00 at any Time during the Year
Did the aggregate value (greater of cost or market value) of all your non-US ﬁnancial accounts exceed the applicable threshold based on your residency and ﬁling status? (based on the reporting thresholds below)*

YES Provide details on Schedule "C" Sections 1, 2 & 3.NO
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By drawing my signature in the box, I certify that the information provided is true, accurate & complete *

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