anata Rene Agence dy vena Protected B whon completed Old Age Security Return of Income 2019 9 Identification Information about you First name and initial Enter your Canadian social Hope insurance number (SIN): | 4) 43|31510/91319 Last name Year © Month Day ‘Osborne _ Enter your date of birth: 491 4;8]0)4/2)8 Mailing address: Apt No. — Street No. Street name 318 Markham St (c/o Aisha Green) ‘Your language of correspondence: 7] English PO Box RR ‘Votre langue de correspondance: __[] Francais oy Prov Ten] Postal Gods Ts this return for a deceased person? ‘Toronto Jon 1G]2)K)9|| | Ifthis return is for a Ye Month Day Country deceased person, i I | Canada enter the date of death: it 1 1 Marital status Email address By providing an email address, you are registering to receive email notifications ftom the GRA ard agree to Tick the box that applies to your marital status on December 31, 2019: the Terms of use on page 7 of the guide. 2D] Living common-law 3] Widowed Email address: jvorced 5 [_] Separated 6D Single Tnformation about your spouse or Information about your residence common-law partner (it you ticked box 1 or 2 above) Enler your county of residence on December 31, 2018: Jamaica Enter their SIN: I you became or ceased to be a resident of Car Enter their first name: {for income tax purposes in 201! Month Day ‘Your old age security number entry _s |, J or departure |_, | 1 |] | enter your old age ‘Tax or pension account number security number: sasasoess in your country of residence: indus ees] Include your world income on this return. World income Is income from all sources both Inside and outside Canada. Income Old age security pension (read line 11300 in the guide) 11300, 665] 14 ‘Canada or Quebec Pension Plan benefits (read line 11400 in the guide) 11400 + 742| 96 Other pensions or superannuation (read line 11500 in the guide) 41500 + [ Interest and other investment income (see the worksheet on page 2) 42100 + Net rental income (read line 12600 in the guide) 12600 + Registered retirement savings plan income (read line 12900 in the guide) 12900 + ‘Other income (read line 13000 in the guide) Specity: 13000 + ‘Net business income (read line 13500 in the guide) 13500 + ‘Add lines 11300 to 13500 This is your total world income. 15000 = 7,401 10 Donotuse this area] 17100 T1196 (19), (Ce forrmutaire est disponible en trangais.)Deductions ——= Carrying charges and interest expenses (read Tine 22100 inthe guide) 22100_ Other deductions (read line 23200 In the guide) | Specity: ae ‘Add lines 22100 and 23200 '23300= > - —— Line 15000 minus line 23300 (W negative, enter"0") This is your net world income. 24200 = Refund or balance owing (Old age security recovery tax (read line 23500 in the guide). If line 24200 is CANS77,580 or less, enter *0" 23500, = Recovery tax withheld from box 27 of your NR4-OAS sip ‘43700 = Oo Line 23500 minus line 43700. This is your refund or balance owing. = o tthe result is negative, you have a refund. Ifthe results positive, you have a balance owing. Enter the ammount below on whichever line applies. f/__ General, we do not charge or refund a diference of $2 or less. Refund 48400 : Balance owing 48500, L_o° (“donstusetnisarea —[ aee00 TH For more information on how to make your payment, see line 48500 in the guide or {90 to canada.ca/payments. Your payment is due no later than April 30, 2020. | certify thatthe information given on this return and in any documents attached is corret, complete, and fully discloses all my i | Sign here Ate G 8tRD. Pol a To make a false return Dale |Interest and Other Investment Income Worksheet ‘State the names ofthe payers below, and attach any information slips you received. Attach a separate sheet of | paper it you need more space. Interest and dividend income | Total interest and dividend income —1_1 Capital gains (see line 12100 in the guide) Description of property: T Bromoisot | & Ades oat | TOdemaseo | gf caalsan ea) | fencherna emer . . ‘Add lines 1 and 2. Enter this amount on line 12100 on page 1. E is ‘Siu cag moyen co sonplaron an enecson Th ricmaon ce may evden or pupeese coeGoverment efcenads Gowemement uConade on rc PO BOX/ CP 5100 STN/SUCC D SCARBOROUGH ON, ‘CANADA |_ Mince OSBORNE HOPE J SAINT ANN SAINT ANN JAMAICA JAMAICA Jaw PROTECTED B (when completed) PROTEGE B (une fois empl) Canada Rovenve Agence durevons summa ig tay tn ue ns on, NR&(OAS) Bell ior Pe sSorobtetunsuemnrimircescaerartocmtoen at fae eases a aS) REE 2019 1 JAM 443.350 939 NRF333146 443 350 939 set i Meiners a fy oes fa] ina Tis] pir coor 1 fe 44 6,658.14 fa 1,058.57 pe cutee som eintareges saeco ae Pee ero Go récup ner Nonesident recipients nae and adress - Nom et adresse du bénélite non-eisont r Robcteanncee pppoe OSBORNE HOPE J SEMEN SAINT ANN - SAINT ANN JAMAICA SEEUEESEATnewesse saaien oe | . 7 coeur STINTS erin on kept coy oyu recent Canad’ ‘See your Old Age Security Relum of Income Guide for Non Residents ad Federal income Tox Gulde for Non-Residents and Deemed Residents of (Canada for more formation on how to repot your Income. ‘Gross income - This is your ol age seeuly pension Ener this Box 16- ‘amount on ine 11300 of your Section 217 Income Tax and Benefit Retum and your Oa Age Secunty Retum of Income, Box 17 Non-tesident tx withheld - Enter this amount on tine 43700 of ‘your Section 217 Income Tax and Benefit Return Box 27- Recovery tax withheld - Enter ths amount online 43700 of your (id Age Security Retum of Income. Note: Ifyou area resident of Canada for income tax purposes, report tis income and tax withheld on your Ince Tax and Beneft Return forthe Province o teritory where you ved on December 31 ‘Concern ett cople pour vos dossiers CConsutez votre guide Déclaration des revenus pour la Séeurté de la \iellese pour les nonresidents et votre Guide Gimpdt fédéral pour les non-résidents et ls sides réputés du Canada pour en savor pls sur lafagon de déclaror votre rover, Case 16~ Revenu brut - Ceci est votre pension dela Sécurité dela vellesse.Inscivaz os montana a igne 11300 de vote, Declaration de revenus et de prestaions selon fate 217 et votre Décleration des revenus pourla Séourté dela Viellesse Case 17- Impot des non-résidents retenu - Inecrivez ce montant la ligne 43700 de vote Déclaration de revenue de prestations selon Fatle 217 Case 27 Impét de récupération etenu- Inscrivaz co montant la ligne 43700 de vote Déclaration des revenus pour la ‘Steuré dela viellesso. Remarque : Si vous tos un résident du Canada pour les besoins de ‘mpdt sur le revenu,inscrvez ce revend el impd relenu dans votre Declaration de revenus et de prastatons pour ls province oul tmtoire 04 vous résiiozle'31 dScambre,EME Sour Secsre serra mcrae [go Box 7 cP 5100 4 a PR: SSS awit, scam coment L oa 4 — cnr-ca 1821347 FE oso ws Hope oseon ween ome SE Ne as ‘Canada Revenue Agence du revenu Statement of Amounts Paid or Gredited to Non-residents of Canada NR4 Seeatane towne cpeaetetarmret ect mse BD ee — ara i a, a 4] 7 _lssusea] Start, |namenteerer ames | mae tan | Miteraaen ean 2 [isaac SERRE _|weecocmmmarmncton| news meeanse.| Miniter o 4 J 46 CAD fel 742.96 fl 185.76 fl a a ec ee Ee Pm fe 88 Pen 7 sotto Soni hota ee a ost exer cmon e 5 ee 3 i : S SERVICE CANADA = $ Ms HoPE osoRNe REGIE De PENSIONS OU CANADA 318 Mi i L. TORONTOON M6G 2K9 af sarees eotsze | ic it Tee ge ores0an eign ste coprk vo decrtonatrae Canada