Cooper, Ken & Karen.

121 Karen Cooper

2022-03-15 11:01 XXX XX9 454

Canada Revenue Agence du revenu Information Return for Electronic Filing of Protected B
I'l' Agemy d“ Canada
an lndividual's Income Tax and Benefit Return when compieted

Tax year: 2021

The information on this form relates to the tax year shown in the top right corner. Before you fill out this form. read the information and instructions on page 2. The
individual identified in Part A (or the individual's legal representative) must sign Part F. Your electronic filer mustfill out Part C and Part D before submitting your
return. Give the signed original of this form to your electronic filer and keep a copy for yourself.

Part A—
Identification and address as shown on your tax return (mandatory)
name
First Last name Social insurance number
Karen Cooper XXX XX9 454
Mailing address: Apt number— Street number — Street name
29 McBryan Drive
PO Box RR City .
Provfl'err Postal code

Hay Rivet 1
NT XOE 0R3
Get your CRA mail electronically delivered in My Account (optional)
Email Address:

By giving an email address, I am registering to receive email notifications from the CRA and agreeing to the terms of use on page 2.

Part B — Declaration of amounts from your Income Tax and Benefit Return (mandatory)
Enter the following amounts from your return, if applicable:

Total income (line

Taxable income (line 26000)

................................
15000)
..............................
75:002
48 913 g2;
fl Refund
or
(line 48400) ........ 7767 22

TotaI federal non-refundable tax credits (line 35000) ................ 3(266E Balance owing (line 48500) . . . .

Part C — Electronic filer identification (mandatory)

By signing Part F below, declare that the following person or firm is electronically filing the new
I or the amended Income Tax and Benefit Return of the person
named in Part A. Part F must be signed before the return is electronically transmitted.

Name of person or firm: Crowe MacKay LLP

Electronic filer number: A4498

Part D — Document Control number (mandatory)

The document control number generated for my electronic record: A4498213FC7ME
Part E — How do you want to receive your notices of assessment and reassessment? (select one or more of the following
electronic options)

I am registering (as indicated in Part A above) or I am already registered to receive email notifications from the
'
CRA and can view and access my notices of
'

assessment and reassessment online.

D I would like my electronic filer to receive a one time notice of assessment and reassessment electronically in their software and provide me with a copy.

Iunderstand that by ticking (x) this box, am allowing the CRA to electronically provide my assessment
I results and my notices of assessment and
reassessment to the electronic filer (including a discounter) named in Part C. will now receive a copy of I
my notices of assessment and reassessment
from my electronic filer. For more information. see the Express NOA section on page 2.
OR
B I would like to receive paper notices of assessment and reassessment through Canada Post.

I will receive my notices ofassessment and reassessment through Canada Post once my return or amended return has been assessed. If I have already
registered to receive email notifications from the CRA and tick this box, understand that
I I I will not receive a copy of my notice through Canada Post.

Part F — Declaration and authorization (mandatory)

I declare that the information entered in parts A, B and C is correct and complete and fully discloses my income from all sources. I also declare that I have read
the information on page 2, and that the electronic fi|er identified in Part C is filing my return. I allow this electronic filer to communicate with the CRA to correct
any errorsor omissions.

Signatfire\(1ndi\ridual identified in Part A or legal representative) Name and title of legal representative

2022-03-15
Year Month Day HH MM 88

PrivacyAct, personal information bank number CRA PPU 211

lol
T183 E (21) Page 1 of 2 Canada
My"
Cooper, Ken & Karen.121 Kenneth Cooper
2022-03-15 11:01 XXX XX8 589

Canada Revenue Agence du revenu Information Retu rn for Electronic Filing of Protected B
I" Agem" d” cane“
an lndividual's Income Tax and Benefit Retu rn when completed

Tax year: 2021

The information on this form relates to the tax year shown in the top right corner. Before you fin out this form, read the information and instructions on page 2. The
individual identified in Part A (or the individual's legal representative) must sign Part F, Your electronic filer must fill out Part C and Part D before submitting your
return. Give the signed original of this form to your electronic filer and keep a copy for yourself.

Part A — Identification and address as shown on your tax return (mandatory)

First name ,
Last name Social insurance number
Kenneth Cooper XXX XX8 589
Mailing address: Apt number— Street number— Streetname
29 McBryan Drive
PO Box RR City ProvJTerr Postal code

Hay Rivet [
NT XOE 0R3
Get your CRA mail electronically delivered in My Account (optional)
Email Address:

By giving an email address, 1 am registering to receive email notifications from the CRA and agreeing to the terms of use on page 2.

Part B — Declaration of amounts from your Income Tax and Benefit Return (mandatory)
Enter the following amounts from your return, if applicable:

Total income (line ................................

15000) 59,426 §§_ Refund (line 48400) ........ 2[002 76
Taxable income (line 26000) .............................. 531011§§ or
Total federal non—refundable tax credits (line 35000) ................ 2371 ;O_ Balance owing (line 48500) . . . .

Part C— Electronic filer identification (mandatory)

By signing Part F below, decIare that the following person or firm is electronically filing the new
I or the amended Income Tax and Benefit Return of the person
named in Part A. Part F must be signed before the return is electronically transmitted.

Name of person or firm: Crowe MacKay LLP

Electronic filer number: A4498

Part D — Document Control number (mandatory)

The document control number generated for my electronic record: A449821JP564X
Part E — How do you want to receive your notices of assessment and reassessment? (select one or more of the following
electronic options)

I am registering (as indicated in Part A above) or I am already registered to receive email notifications from the CRA and can view and access my notices of
assessment and reassessment online.

D I would like my electronic filer to receive a one time notice of assessment and reassessment electronically in their software and provide me with a copy.

Iunderstand that by ticking (x) this box, I am allowing the CRA to electronically provide my assessment results and my notices of assessment and
reassessment to the electronic filer (incIuding a discounter) named in Part C. i win now receive a copy of my notices of assessment and reassessment
from my eiectronic filer. For more information, see the Express NOA section on page 2.

OR
I would like to receive paper notices of assessment and reassessment through Canada Post;
[:1
I will receive my assessment and reassessment through Canada Post once my
notices of return or amended return has been assessed. If I have already
registered to receive emai! notifications from the CRA and tick this box, understand that l I I will not receive a copy of my notice through Canada Post.

Part F — Declaration and authorization (mandatory)

I declare that the information entered in parts A, B and C is correct and complete and fully discloses my income from ail sources. I also declare that I have read
the information on page 2, and that the eiectronic filer identified in Part C is filing my return. I allow this electronic filer to communicate with the CRA to correct
any errors or omissions.
\
Signéture (individual identified in Part A or legal representative) Name and title of legal representative

2022-03-15
Year Month Day HH MM 88

PrivacyAct, personal information bank number CRA PPU 211

Id
T183 E (21) Page 1 0f 2 canada,
 Crewe
Crowe MacKay LLP
5103 51st Street PO Box 727
YelIowknife, NT X1A 2N5

March 15, 2022

Karen Cooper
29 McBryan Drive
Hay Rivet, NT
XOE 0R3

PLEASE SIGN AND RETURN TO: CROWE MACKAYyi’

Dear Karen

Re: Personal Tax Return E_r1gaqement Letter

We appreciate the opportunity of working with you in preparing your personal income tax return.
Please read carefully the contents of this letter, which sets out our respective obligations, the
limitations upon our liability, and other terms pursuant to which Crowe MacKay LLP is pleased to
accept this engagement. If the terms and conditions proposed for this engagement meet with
your approval, please execute the fourth page of the duplicate copy of this letter enclosed and
return the signed copy to us.

We will prepare your personal tax return from the information provided by you. You must do so in
a timely manner sufficient to reasonably permit us to complete this engagement. You alone are
solely responsible for the accuracy and completeness of the information provided to us to
complete your personal income tax return. We will not audit, review or otherwise attempt to verify
the accuracy or completeness of any information provided, nor will we be responsible for failing to
prevent or detect errors or other irregularities in the information provided to us.

You agree to hold harmless and indemnify Crowe MacKay LLP and its individual Chartered
Professional Accountants and employees from any penalty or costs arising pursuant to Section
163.2 of the Income Tax Act, as a consequence of false or otherwise incorrect information
supplied by you or your agents to Crowe MacKay LLP for the purpose of providing any taxation
,

services to you, including but not limited to tax planning or the preparation and filing of income tax
returns.

Our fee for the preparation of your personal tax return will be determined based upon the
complexity of your personal income tax return, the amount of effort required to complete your
return, and our commitment to be fair to our clients and provide value for our professional
services. you require additional tax planning advice, we would be pleased to provide these
If

engagement at our normal hourly rates, Our billings will

additional services as part of this
normally be rendered on completion of the engagement. Our fees for services are due and
payable within 30 days of receipt of our account. Invoices unpaid within this time period may be
deemed delinquent. Interest at a rate of 1.5% per month (19.56% per annum) is charged on
overdue accounts.

Costs of responding to Canada Revenue Agency, Government or legal processes may arise. We
willassist you in providing additional information or explanations reiated to our preparation of your
return, should any taxation authorities subsequently request it. In the event we are required to
respond to an assessment or enquiry, a subpoena, court order, government agency, or other
legal processes for the production of documents and/or testimony reiative to information we
obtained and/or prepared during the course of this engagement, you agree to compensate us at
our normal hourly rates for the time we expend in connection responding.
The total of all claims you may have against Crowe MacKay LLP and its individual Chartered
Professional Accountants and employees under this engagement, including but not limited to
claims for negligence, negligent misrepresentation and breach of contract shall be strictly limited
to theamount of $10,000. If this limit of liability is insufficient for your purposes, we would be
pleased to discuss with you a different limit that may result in our charging a higher fee.

You further expressly agree to the foIlowing additional limits upon our liability: (1) The liability of
Crowe MacKay LLP, its partners and staff shall absolutely cease to exist after a period of four
years from the date of our completion ofthe engagement; (2) You will not bring any proceedings
in any court of any jurisdiction advancing any claim against our individual professional staff and

employees; and (3) Any liability Crowe MacKay LLP may have to 'you shall not be joint and
several with any other party, but shall be several, and limited to the percentage or degree of our
the fault or wrongdoing of all persons who contributed
fault in proportion to to the loss arising
from the claim, including and without limitation, any fault on your part.

The terms of this agreement shall continue in force from year to year unless superseded by a
subsequent agreement in writing. The terms are subject to the laws of the jurisdiction of the office
of the firm preparing the tax filings. The courts of the jurisdiction will have exciusive jurisdiction in
relation to any claim, dispute or difference concerning this engagement letter and any matter
arising from it.

You agree that prior to requiring Crowe MacKay LLP to respond to any litigation, any dispute that
may arise regarding the meaning, our performance or the enforcement of this engagement letter
agreement will first be submitted to mediation and that we will both engage in the mediation

process good faith once written request to mediate has been given by you or the firm. The
in

results of such mediation shall be binding only upon agreement of each party to be bound. The
costs of any mediation proceeding shall be shared equally by the participating parties.

The law governing the handling of personal information about identifiable individuals requires us
to inform you about the use of any personal information which is supplied to us. Our firm has
established a privacy policy under which we collect, use, disclose and retain personal information
about identifiable individuals. This policy is revised from time to time, is available [upon request or
on our website] and is incorporated by reference into and part of this engagement letter. By
signing this engagement letter you are consenting to our collection, use, disclosure and retention
of personal information in accordance with the terms in our policy.

One of the underlying principles of the accounting profession is a duty of confidentiality with
respect to client affairs. You agree that we may use your confidential information as needed for
the completion of other family members’ tax returns, such as a spouse, child or parent. If you put
us in direct contact with
your other advisers (such as lawyers, bankers and brokers), you consent
to us providing them such
confidential information regarding your affairs that is in our discretion
necessary to perform our tasks under this engagement. Otherwise, except for information that is
in or enters the public domain, we will not provide any third party with confidential information

concerning your affairs without your prior consent, unless required to do so by lawfu! authority, or
by our Rules of Professional Conduct.
To facilitate efficiency and timeliness in communications between us, Crowe MacKay LLP may
Choose to use an electronic signature facility when we ask you to sign and return certain
documents to us. Crowe MacKay LLP currently uses Citrix RightSignature to complete electronic
signing of documents. You may at any time decline to use electronic signatures and may instead
ask to sign documents manually on paper and return either a scanned electronic copy of the
document, an original copy of the document via mail, or a copy of the signed document via fax. If
you choose to use the electronic signature facility however, it is understood and agreed that:
0 Instructions in its use will be provided to you anytime we ask you to sign a document
electronically.

o The electronic signature will have the same force in law as an original hand-written
signature.
 0 Our obligations for and your entitlement to confidentiality will be the same as for all other
information and communications between us.

. The Citrix RightSignature Signature Certificate, generated with each use of the faciiity,

will be used to verify the authenticity of your electronic signature.

. Upon execution of the electronic signature on a document, all parties will receive a copy
document via email.
of the signed

. You will be responsible for maintaining a copy of the final document for your records.

Your data will be hosted in an environment where reasonable security measures, both physical
and logical, have been taken to secure it from unauthorized access, modification, theft, misuse or
destruction. Data will be stored in Canada whenever possible. During the course of our
engagement with you, we may need to use third party service providers for their services or data
storage (the “Service Providers”). These Service Providers may be located inside or outside of
Canada.

Crowe MacKay LLP and any Service Provider retained by us will maintain an adequate leve! of
physical security controls over its facility and maintain an adequate level of data security controls.
Please note that personal and/or confidential information processed and stored outside of
Canada by a Service Provider may be subject to disclosure in accordance with the laws
applicable in thejurisdiction in which the information is processed or stored which laws may not
provide the same level of protection for such information as will Canadian laws.

If we choose to employ services or storage accessed through Service Providers in connection

with our engagement with you, you consent to:
1. Crowe MacKay LLP releasing your personal and/or confidential information to the Service
Provider engaged to provide services;

2. Uploading of your data as requested by us to the secure website or service of our choice;
and

3. Services, such as analysis of your data, by the third party service provider according to
parameters established by us.

It our policy to use an internally hosted portal sofh/vare "Doc.lt” ("Doc.lT") as the on-line service
is

for the purposes of file sharing. Where you authorize and/or request Crowe MacKay LLP (either
in writing or verbally) to use any remote access service or other file sharing service other than

Book to download, upload, amend, or otherwise access in any manner your information stored
and/Iocated on such file sharing services, you acknowledge that this may lead to a loss or
unintended exposure of your confidential information to unintended audiences, or, in the case of
remote access services, potential damage or loss to your computer system or documents. You
expressly accept that any such exposure and/or release of confidential information, or damage to
your computer system or documents as a resultof using such services will not be the
responsibility of Crowe MacKay LLP and you will indemnify us for any losses incurred by you as a
result of loss or exposure of your information arising from the use of such file sharing or remote
access servaces.

It is important that the personal data held

by us on individuals is accurate and up to date. Please
inform us of any changes in personal details by writing to us to the attention of your engagement
pannen
Thank you for doing business with Crowe MacKay LLP!

Yours very truly,

"Crowe MacKay LLP"

l have read and accept the terms of your engagement as set out in this letter.

Accepted: { Date
Karen Cooper

My preferred email address to be used for correspondence with Crowe Mackay is:

I confirm that my responses to the following matters are accurately answered by way of
my mark.

Please comglete the following: No Yes

I am a US. Citizen, US. Green Card holder or dual citizen 0 O

I spent more than 30 days in the US.
in 2021 and the number of days was 0 O
I owned foreign assets with an aggregate cost greater than $100,000
at any time during 2021 (complete the Foreign Income Verification Statement 0 O
https:IIwww.crowe.comIca/crowemackaylinsightslforeign-income-verification-statement)

I disposed of real estate during 2021 O 3/7919

I changed all / part of my principal residence to a rental or business operatiorya/ O
I changed all / part of my rental or business operation to a principal residencefi/ O
 Crowe MacKay LLP
5103 51st Street PO Box 727
Yellowknife, NT X1A 2N5

March 15, 2022

Kenneth Cooper
29 McBryan Drive
Hay Rivet, NT
XOE 0R3

PLEASE SIGN AND RETURN TO: CROW: MACKAYI:I_._E

Dear Kenneth

Re: Personal Tax Return Enqaqement Letter

We appreciate the opportunity of working with you in preparing your personal income tax return.

Please read carefully the contents of this letter, which sets out our respective obligations, the
limitations upon our liability, and other terms pursuant to which Crowe MacKay LLP is pleased to
accept this engagement. If the terms and conditions proposed for this engagement meet with
your approval, please execute the fourth page of the duplicate copy of this letter enclosed and
return the signed copy to us.

We will prepare your personal tax return from the information provided by you. You must do so in
a timely manner sufficient to reasonably permit us to complete this engagement. You alone are
solely responsible for the accuracy and completeness of the information provided to us to
complete your personal income tax return. We will not audit, review or otherwise attempt to verify
the accuracy or completeness of any information provided, nor will we be responsible for failing to
prevent or detect errors or other irregularities in the information provided to us.

You agree to hold harmless and indemnify Crowe MacKay LLP and its individual Chartered
Professional Accountants and employees from any penalty or costs arising pursuant to Section
163.2 of the Income Tax Act, as a consequence of false or otherwise incorrect information
supplied by you or your agents to Crowe MacKay LLP for the purpose of providing any taxation
services to you, including but not limited to tax planning or the preparation and filing of income tax
returns.

Our fee for the preparation of your personal tax return will be determined based upon the
complexity of your personal income tax return, the amount of effort required to complete your
return, and our commitment to be fair to our clients and provide value for our professional
services. you require additional tax planning advice, we would be pleased to provide these
If

additional services as part of this

engagement at our normal hourly rates. Our billings will
normally be rendered on completion of the engagement. Our fees for services are due and
payable within 30 days of receipt of our account. Invoices unpaid within this time period may be
deemed delinquent. Interest at a rate of 1.5% per month (19.56% per annum) is charged on
overdue accounts.

Costs of responding to Canada Revenue Agency, Government or legal processes may arise. We
willassist you in providing additional information or explanations related to our preparation of your
return, should any taxation authorities subsequently request it. In the event we are required to
respond to an assessment or enquiry, a subpoena, court order, government agency, or other
legal processes for the production of documents and/or testimony relative to information we
obtained and/or prepared during the course of this engagement, you agree to compensate us at
our normal hourly rates for the time we expend in connection responding.
The total of all claims you may have against Crowe MacKay LLP and its individual Chartered
Professional Accountants and employees under this engagement, including but not Iimited to
claims for negligence, negligent misrepresentation and breach of contract shall be strictly limited
to theamount of $10,000. If this limit of liability is insufficient for your purposes, we would be
pleased to discuss with you a different limit that may result in our charging a higher fee.

You further expressly agree to the following additional limits upon our Iiability: (1) The liability of
Crowe MacKay LLP, its partners and staff shall absolutely cease to exist after a period of four
years from the date of our completion of the engagement; (2) You will not bring any proceedings
in any court of any jurisdiction advancing any claim against our individual professional staff and

employees; and (3) Any liability Crowe MacKay LLP may have to you shall not be joint and
several with any other party, but shall be several, and limited to the percentage or degree of our
the fault or wrongdoing‘of all persons who contributed
fault in proportion to to the loss arising
from the claim, including and without limitation, 'any fault on your part.

The terms of this agreement shall continue in force from year to year unless superseded by a
subsequent agreement in writing. The terms are subject to the laws of the jurisdiction of the office
of the firm preparing the tax fiiings. The courts of the jurisdiction will have exclusive jurisdiction in
relation to any claim, dispute or difference concerning this engagement letter and any matter
arising from it.

You agree that prior to requiring Crowe MacKay LLP to respond to any litigation, any dispute that
may arise regarding the meaning, our performance or the enforcement of this engagement letter
agreement be submitted to mediation and that we will both engage in the mediation
will first

process in good faith once written request to mediate has been given by you or the firm. The
results of such mediation shall be binding only upon agreement of each party to be bound. The
costs of any mediation proceeding shall be shared equally by the participating parties.

The Iaw governing the handling of personal information about identifiable individuals requires us
to inform you about the use of any personal information which is supplied to us. Our firm has
established a privacy policy under which we collect, use, disclose and retain personal information
about identifiable individuals. This policy is revised from time to time, is available [upon request or
on our website] and is incorporated by reference into and part of this engagement letter. By
signing this engagement letter you are consenting to our coIIection, use, disclosure and retention
of personal information in accordance with the terms in our policy.

One of the underlying principles of the accounting profession is a duty of confidentiality with
respect to client affairs. You agree that we may use your confidential information as needed for
the completion of other family members’ tax returns, such as a spouse, child or parent. If you put
us in direct contact with your other advisers (such as lawyers, bankers and brokers), you consent
to us providing them such confidential information regarding your affairs that is in our discretion
necessary to perform our tasks
under this engagement. Otherwise, except for information that is
in or enters the public domain, we will not provide any third party with confidential information
concerning your affairs without your prior consent, unless required to do so by lawful authority, or
by our Rules of Professional Conduct.
To facilitate efficiency and timeliness in communications between us, Crowe MacKay LLP may
choose to use an electronic signature facility when we ask you to sign and return certain
documents to us. Crowe MacKay LLP currently uses Citrix RightSignature to complete electronic
signing of documents. You may at any time decline to use electronic signatures and may instead
ask to sign documents manually on paper and return either a scanned electronic copy of the
document, an original copy of the document via mail, or a copy of the signed document via fax. If
youphoose to use the electronic signature facility however, is understood and agreed that:
it

. Instructions in its use will be provided to you anytime we ask you to sign a document
electronically.

o The electronic signature will have the same force in law as an original hand-written
signature.

\Q
 0 Our obligations for and your entitlement to confidentiality will be the same as for all other
information and communications between us.

0 The Citrix RightSignature Signature Certificate, generated with each use of the facility,

will be used to verify the authenticity of your electronic signature.

. Upon execution of the electronic signature on a document, all parties will receive a copy
of the signed document via email.

. You will be responsible for maintaining a copy of the final document for your records.

Your data will be hosted in an environment where reasonable security measures, both physical
and logical, have been taken to secure it from unauthorized access, modification, theft, misuse or
destruction. Data will be stored in Canada whenever possible. During the course of our
engagement with you, we may need to use third party service providers for their services or data
storage (the “Service Providers”). These Service Providers may be located inside or outside of
Canada.

Crowe MacKay LLP and any Service Provider retained by us will maintain an adequate level of
physical security controls over and maintain an adequate level of data security controls.
its facility

Please note that personal and/or confidential information processed and stored outside of
Canada by a Service Provider may be subject to disclosure in accordance with the laws
applicable in the jurisdiction in which the information is processed or stored which laws may not
provide the same level of protection for such information as will Canadian laws.

If we choose to employ services or storage accessed through Service Providers in connection

with our engagement with you, you consent to:

1. Crowe MacKay LLP releasing your personal and/or confidential information to the Service
Provider engaged to provide services;

2. Uploading of your data as requested by us to the secure website or service of our choice;
and
3. Services, such as analysis of your data, by the third party service provider according to
parameters estab|ished by us.

It our policy to use an internally hosted portal software ”Doc.lt" ("Doc.lT") as the on—line service
is

for the purposes of file sharing. Where you authorize and/or request Crowe MacKay LLP (either
in writing or verbally) to use any remote access service or other file sharing service other than

Doc.lt to download, upload, amend, or otherwise access in any manner your information stored
and/located on such file sharing services, you acknowledge that this may lead to a loss or
unintended exposure of your confidential information to unintended audiences, or, in the case of
remote access services, potential damage or loss to your computer system or documents. You
expressly accept that any such exposure and/or release of confidential information, or damage to
your computer system or documents as a result of using such services will not be the
responsibility of Crowe MacKay LLP and you will indemnify us for any losses incurred by you as a
result of loss or exposure of your information arising from the use of such file sharing or remote
access services.

It is important that the personal data held

by us on individuals is accurate and up to date. Please
inform us of any changes in personal details by writing to us to the attention of your engagement
pannen
Thank you for doing business with Crowe MacKay LLP!

Yours very truly,

"Crowe MacKay LLP"

I have read and accept the terms of your engagement as set out in this letter.

Accepted: K Date
Kenneth Cooper

My preferred email address to be used for correspondence with Crowe Mackay is:

I confirm that my responses to the following matters are accurately answered by way of
my mark.

Please comglete the following: No Yes

I am a US. Citizen, US. Green Card holder or dual citizen 0

I spent more than 30 days in the US.
in 2021 and the number of days was
‘

O
I owned foreign assets with an aggregate cost greater than $100,000
at any time during 2021 (complete the Foreign Income Verification Statement 0
httpszllwww.crowe.comlcalcrowemackaylinsightslforeign—income-verification-statement)

| disposed of real estate during 2021 O

I changed all / part of my principal residence to a rental or business operation 0
I changed all / part of my rental or business operation to a principal residence 0
 & Karen.121 Karen Cooper
Cooper, Ken
2022-03-15 10:53 XXX XX9 454

PTOteCted B when completed

Canada Revenue Agence du revenu
'* Agency du Canada

Joint Election to Split Pension Income for 2021

If you are filing a paper return. you must complete, sign, and attach copies of this form to both your return and your spouse or
common—law partner's return.

The information on the forms must be the same. If you are filing electronically, keep this form in case we ask to see it later.
Complete this form if you (the transferring spouse or common-law partner) are electing to split your eligible pension income with your spouse or common-law
partner (the receiving spouse or common—Iaw partner) and if you meet all of the following conditions:

a You and your spouse or common-law panner were not living separate and apart from each other, because of a breakdown in your marriage or common-Iaw
relationship, at the end of the tax year and for a period of 90 days or more beginning in the tax year.
0 You and your spouse or common-law partner were residents of Canada on December 31, 2021 (or on the date of death).
a You received pension income in the tax year qualifying for the pension income amount (see "Retirement income— Summarytable" in the Appendix of the

Federal Income Tax and Benefit Guide) or you were 55 years of age or older and received certain qualifying amounts distributed from a retirement
compensation arrangement (Box 17 of yourT4A-RCA siips).

Only one joint election can be made for a tax year. If both you and your spouse or common—Iaw partner have eligible pension income, you need to decide
who will act as the transferring spouse or common-Iaw partner electing to allocate part of their eligible pension income to the other spouse or common—law

partner (the receiving spouse or common-law partner).

This form needs to be filed by your filing due date for the year. For more information on filing due dates, see the Federal Income Tax and Benefit Guide. We may
allow you to make a late or amended election, or revoke an original election, under certain circumstances. Contact us if you need more information.

Step 1 —- Identification
Information about you (the transferring spouse or common-law partner)

Last name First name Social insurance number

Cooper Karen XXX XX9 454

Home address Postal code

29 McBryan Drive Hay Rivet NT XOE 0R3

Information about your spouse or common-Iaw partner (the receiving spouse or common—Iaw partner)

Last name First name Social insurance number

Cooper Kenneth )(XX XX8 589

Home address (if different from above) Postal code

Continued on the next page

T1032 E (21) Page 1 of4

Cooper, Ken & Karen.121 Karen Cooper
2022—03—1 5 10:53 XXX XX9 454

Protected B when completed

Step 2 — Maximum split-pension amount

To calculate the eligibie pension income amount, the transferring spouse or common-law partner must compIete the
calculation for line 31400 on the Federal Worksheet found in the income tax package.
Enter the amount from line 8 of the transferring spouse's or common-Iaw partner's Federal Worksheet for line 31400. 53020 66,891‘84 1

Enter the amount from box 128 of the transferring spouse's or common-law partner's T4A slip. 68025 2
Line 1 minus line 2 66,891 84 3

Qualifying retirement com pensation arrangement (RCA) payments and veteran's benefits
If you were 65 years of age or older on December 31, 2021 (or on the date of death) and received life annuity payments
from an RCA or you received veterans benefits, complete lines 4 to 7. Otherwise, enter "0" on line 8.

Enter the amount from box 17 of the transferring spouse's or common-law

partner’s T4A-RCA slips. 58026 4
Enter the amount from fine 2. 5
Line 4 plus line 5 6
$113,595 minus the amount from line 3 (if negative. enter "0") 7

Enter whichever is less: line 6 or line 7. 8

Line 3 plus line 8 66,891 84 9

Marital status change

If your marital status changed during the tax year, calculate the eligible pension income for the period
that you were married or living common-law. Othewvise, enter the amount from line 9 on line 11.

Number of months married

or living common-Iaw 68030 X Amount from line 9 66,891184 = 10
Number of months 12 Nam
in the tax year
Note 1

If the transferring spouse or common-Iaw partner is deceased, use the number of months up to and including
the month of death.

Enter the amount from line 10, if it applies. Otherwise, enter the amount from line 9. 66,891184 11

Maximum rate X 50 % 12
Line 11 multiplied by line 12 Maximum split-pension amount 33,445{92 13

Step 3 — Elected split—pension amount

Enter the amount that you and your spouse or common-law partner decide to jointly elect to be your split—pension amount for
the year. The split-pension amount cannot be more than the amount from line 13. 22,074‘31 14
Enter this amount on line 21000 of the transferring spouse's or common-law partner's return and on line 11600 of
the receiving spouse's or common-law partner's return.

Step 4 —— Pension income amount (line 31400)

Part A — Calculate the pension income amount of the transferring spouse or common-law partner
Amount from line 1 66,891 84 15
See Note 2 on page 3. 22,074 31 16
Line 15 minus line 16 2,000 00 17
Enter $2,000 or the amount from line 17, whichever is less, on line 31400 of the transferring
spouse or common-law partner's return.

Continued on the next page

T1032 E (21) Page 2 of 4

i}
Cooper, Ken & Karen.121 Karen Cooper _

2022-03-15 10:53 XXX XX9 454

Protected B when completed

Note 2
If the transferring spouse or common—Iaw partner entered an amount on line 8, complete lines 18 to 26. Enter the result from line 26 on line 16.

Otherwise, enter the amount from line 14 on line 16.

Amount from line 14 22,074'31 18

Amount from line 8 19
Amount from line 5 20
Line ‘19 minus line 20 21

Amount from line 9 66,891 84 22

Line 21 divided by line 22 1
23
Amount from line 14 22,074 3 1 24
Line 23 multiplied by line 24 > 25
Line 18 minus line 25 22,074 31 26

Part B —- Calcuiate the pension income amount of the receiving spouse or common-law partner
If there is an amount on fine 11500 or line 12900 of the receiving spouse's or common-law partner's return, enter the amount
from line 8 of their Federal Worksheet for line 31400. Otherwise. enter "0". 25,70112 27
Amount from line 16, unless Note 3a below applies 22,07431 28
Line 27 plus line 28 2,000 00 29
Enter $2,000 or the amount from line 29, whichever is less, on line 31400 of the receiving spouse's
or common—Iaw partner's return.

Note 3a
If all of the following conditions apply, see Note 3b below:
0 the amount on line 27 is less than $2,000
0 the receiving spouse or common-Iaw partner was under age 65 on December 31, 2021
0 the transferring spouse or common-Iaw partner was age 65 or older and received any:
—- RRIF, RRSP, or other annuity payments
— variable pension benefits paid from a money—purchase provision of a registered pension plan
— payment out of a pooled registered pension plan (other than amounts received due to the death of their former spouse or common-law partner)
- veteran's benefits included on line 2

Note 3b
1f Note 3a applies, calculate the amount to enter on line 28 as follows:

1) Recalculate the amount on line 3 by deducting any of the following sources of pension income:
—- RRIF, RRSP, or other annuity payments received by your spouse or common—Iaw padner
— variable pension benefits paid from a money purchase provision of a registered pension plan
— any payment out of a pooled registered pension plan (other than amounts received due to the death of their former spouse or common-law partner)

2) If the result from 1) above is $4,000 or more, enter on line 28 the amount from fine 16.

3) If the result from 1) above is less than $4,000, recalculate steps 2 and 3 only using the result from 1) as the amount for line 9. Enter on line 28
the lesser of the amount from line 14 or 16.

Continued on the next page

T1032 E (21) Page 3 of 4

13
Cooper, Ken & Karen.121 ,
Karen Cooper
2022-03-15 10:53 XXX XX9 454

Protected B when completed

Step 5 — Income tax deducted (line 43700)

Enter the total tax deducted from the transferring spouse's or common-law partner's pension income
68040 -
entered on line 9. Note 4 13,800124 30

Note 4
If the transferring spouse's or common-Iaw partner‘s information slip(s) include(s) income tax deducted for both eligible and non-eligible
pension income on the same slip, caiculate the proportionate amount of tax deducted to be included at line 30 for each slip as follows:
(Efigible pension + total of eligible and non-eligible pension) x total tax deducted

Calculation for the tax deducted for the elected split—pension amount

Amount from line 30 13,800{Z4 X Amount from line 14 22,074‘31 = GSOSO—E ' 31

Amount from line 9 66,891184

Part A — Calculate the income tax deducted for the transferring spouse or common-law partner

Total tax deducted from all of the transferring spouse or common-law partner's slips. Note 5 17,197 07 32
Amount from line 31 4,554 08 33
Line 32 minus line 33 121642 99 34

Enter the result on fine 43700 of the transferring spouse's or common-law partner's return.

Part B —- Calculate the income tax deducted for the receiving spouse or common-law partner

Total tax deducted from all of the receiving spouse or common-Iaw partner's slips. Note 5 4,774 47 35
Amount from line 31 4,554 08 36
Line 35 plus line 36 9,328 55 37

Enter the result on line 43700 of the receiving spouse's or common-law partner's return.

Note 5
Enter the amount that you would have entered on line 43700 of your return if you did not choose to split your eligible pension income.
If you were a resident of Quebec on December 31, 2021, do not include any of your Quebec provincial income tax deducted.

Step 6 —- Joint certification

By completing this form and signing below, we jointly elect and certify that the sptit—pension amount entered on line 14 of
Step 3 be deducted in computing the net income of the transferring spouse or common-law partner and reported as
will

income by the receiving spouse or common-Iaw partner on our income tax and benefit returns for 2021.

We understand that we will be jointly and severally liable for any amounts of tax, interest and penalties that may be owing as a result of this election.

)\ Date 2022-03-15

SigKre of transferring spouse or common-law partner ( Karen )

Date 2022-03-15
Signature of receiving spouse or common-Iaw partner ( Kenneth )

It is a serious offence to make a false statement.

See the privacy notice on your return.

T1032 E (21) Page 4 of4

H5
 Crowe MacKay LLP
Member Crowe Horwath International
PO Box 727, 5103 — 515t Street
Yellowknife, NT X1A 2N5
+1.867.920.4404 Tel
+1.867.920.4135 Fax
+1.866.920.4404 Toll Free
www.crowemackayca

IN ACCOUNT WITH
COOPER, KAREN Invoice No. 386693
29 McBryan Drive
Hay River, NT XOE 0R3 Date 03/15/2022
Client N0. A21052. 001

Fee for services rendered for preparing your income tax return
T2222 — Northern Residents Deduction
T2125 Business Income and Expenses
T1032, Pension Split $ 1,100.00
Total 1,100.00
GST 55.00
Total Due Stééiiflg

G S T/HS T Registration number: 7 2266046 7R T0001

DUE AND PAYABLE ON RECElPT

Accounts are due as rendered, Interest at 1.5% per month (19.56% per year) is charged from the invoice
date on accounts unpaid after 30 days.

Visa, MasterCard and AMEX payments are accepted: -Invoice:386693 A21052

Cardholder Name: Signature:

Card Number: CVW: Expiry Date: /