Canada Revere Agence di rovonu Agency ot Conada Old Age Security Return of Income First name and initial Hope Last name Osborne Mailing address: Apt No. — Street No. Steet name 318 Markham St (c/o Aisha Green) PO Box F iy ProviTerr.| Postal Code Toronto on M 6,6) 2)K)9) Country Canada | understand that by providing an email address, | am registering for online mail. | have read and | accept ‘the terms and conditions on page 7 of the guide. Email address: Eee eae Enter your country of residence on December 31, 2017: If you became or ceased to be a resident of Canada for income tax purposes in 2017, enter the date of: Month Day Month Day entry or departure ‘Tax or pension account number in your country of residence: Protected B when competes 2017 [iene ree Enter your Canadian social insurance number (SIN): | 4) 4) 3|3)5)0|9 3,9 Year — Month Day 1,9) 4)8]0 4/28 English CO Francais Enter your date of birth: ‘Your language of correspondence: Votre langue de correspondance : Is this return for a dec It this return is for a ‘deceased person, enter the date of death Sener Month Day riititli Renee ‘Tick the box that applies to your marital status on. December 31, 2017: 10) Maried Divorced 5 [1] Separated 201] Living common-aw [7] Widowed 61 Single Men aes ‘common-law partner (it you ticked box 1 or 2 above) Enter his or her SIN: Enter his or her firstname: EME Enter your old age security number 443350939 Do not use this area 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 113 in the guide) 113 2st) 12 Canada or Quebec Pension Plan benefits (read line 174 in the guide) 114+ 178] ee ‘Other pensions or superannuation (read line 115 in the guide) 115+ [ interest and other investment income (see the worksheet on page 2) 121+ Net rental income (read line 126 in the guide) 126+ Fogistered retirement savings plan income (read ine 128 in the guide) 429+. Other income (read line 130 in the guide) Specity: a _ 130+ ‘Net business income (read line 1951n the guide) 135+ ‘Add lines 113 to 135 This is your total world income. 150 = 493} al ‘Do not use this area ree)ene ee Protected B nhon complied Deductions Carrying charges and interest expenses (ead line 221 in the guide) 221 | ‘Other deductions (read line 232 in the guide) Specity 232+ | ‘Add lines 221 and 232 - 233 = Les Line 150 minus line 233 (if negative, enter "0") This is your net world income. 242 = Refund or balance owing ‘Old age security recovery tax (read line 235 in the guide). 6 Itline 242 is CANS74,788 or less, enter "0" : Flecovery tax withheld trom box 27 of your NR4-OAS slip Us Line 235 minus line 437. This is your refund or balance owing. oc lt the result is negative, you have a refund. Ifthe result is positive, you have a balance owing. Enter the amount below on whichever line applies. ¥_ Genarally, we do not charge or refund a difference of $2 orless. Refund 484 : Balance owing 485 e Do not use this areal[ass] |] For more information on how to make your payment, see ine 485 in the quide or 0 to canada.ca/payments. Your payment is due no later than April 30, 2018. | certify that the information given on this return and in any documents attached is correct, complete, and fully 13.2020. 16421-4090) 416-333-6932 OYE Ge ome discloses all my in Sign here, isa Serious offence to make 8 false return Interest and Other Investment Income Worksheet State the names of the payers below, and attach any information slips you received. Attach a separate sheet of Paper if you need more space. Interest and dividend income Total interest and dividend income Capital gains (see line 121 in the guide) Description of property: 1 Proceeds of [2 Adjusted cost ‘spostion ase 3, Outlays and expenses ‘rom cisposttons) 4 Caplal gain (oot (bow mines Zand) ‘Taxable capital gains (50% of the amount in box 4 above). Ifthe amount in box 4 is negative, enter "0" ‘Add lines 1 and 2. Enter this amount on line 121 on page 1 Persona informations cobacted under the como Tax At {he adransaton or enorcemant lhe Act uch as audovert CGowtememee PROTECTED 8 when compiaad) HoH cama oiConace PROTEGE 8 (ane fle remp) a Reve (evel ect ne i ere te RA (OA Well Segoe Seema etait saat, (0As) para ana earae ns SaaS) SST wr | + aM 49380080 rs00146 “459050 909 fot oororancne| ose | artemsmeenines | wrtomenarnaene | “iii” tel ee oar ae ir 1 a 44 a ‘CAD fa 2314.12 fae ‘578.52 ube | adie | enna ee st ee co soengtn Ear saosin falcon paras Lids [esranasassatn | com siete mts snromers Nonsient repent name and sddes- Nom adresse du bine non cant, T Tease popes ooops (OSBORNE HOPE J OCHO RIS PO SAINT ANN, JAMAICA aM a osy Ifyou ae electing under Secon 217 of te Income Tax Act to epan te Income, attach scopy to your Secton 217 Income fx tum, ‘See your Ot Age Security Ret ol ncome Gud for Non-Rasisents and Genera ncome Tax and Bonalt Gado lor Non ledent and Deemed Festznts of Canada for moe ifomaton on how lo opt your income. Box 16- Gross income - This is you okt age secur pension Enter tis amount on ine 113 of your Soci 217 came Wx totum and You" OW Age Sccury Ratu of Income, 80x 17- Non-resident tax withhold - Eta this amount an ine 427 of Your Seton 217 inoome ax return ‘80x 27- Recovery tax withineld- Enter Tis amount onne 437 ef your (OiAge Security Retur of coma. Noe: it you aro a rsiant ot Canada for income tx purposes, epee Income ana ax wil on your insamo ax rtm Ua roves eeory ‘where you lve on Decomber 3 [Atach ls copy to your Seton 217 income x tun Jlgne eat cope Ave Decoration sson ane 7 ‘SERVICE CANADA Sto cae Secumy SERVICE CANNON SeovRTEbe Va esse Canada ‘1 vous exerosz le cho pr 8 farce 217 doa Loi do Fp sur lo ‘feu cles eve, lee cote cop ha cecaaton sen joa? Consutes votre quid Déclaraton des reverus pow la Sécurit do la vellesse pour ls non rbsidents ol votre Guise gondral dred of do Prosatone pour les norséeidenis ee retirterouhoe cu Canada our en savor pus sur la aron de détarar vove oven. (Case 18- Revenu brut - Cox est votre pension do la Sdcutd a Vollesse inser ce moni a bg 113.00 vote ‘ctaraton selon aria 217 et voto Dilation dos Caso 17-impot des non-residents rotonuiecivez co montant la ligne 457 ge wove dedaraon scion Farida 217 (case 27 Impot de recupéralionretenu : Inscvex oo montant a "emp sre reveru,insciverce reve a inpdt olen Gans votre ‘elaraton oe evenus pour la province ou le etre ob vous résdez Ie Sr ascenb'epn covenant ores a seesasy HOnENpesia sags faite: fis Semen. men sSpencasSaatlninmnnsncnons (ETSY Se Rewn_ sores snmuigusinameytenormenetce, =e a ST eee 1 JAM 443 350 939 NRF333146 443 350 939 a oe aamn| 2 | untewamanane | matranrgrenaien | “Seats cipegmene Late | ___arireeennmien | = aes Ee 44 a CAD ft 2,314.12 er $78.52 cates | cto aan mami, | enema Lay esos; Lema a acisineitn | aioe ineuingtan ie ranan rant mas anaes es Sana itain Sa ae cr Ss Serna ossonne ores seeseatet, seorers ‘SAINT ANN: Sr nl se sara 2 teune a un (as) ‘Atwch Bis copy io your Ott Age Secunty Retun of Income. See your Ot Age Securty Retum of Income Guide for Nor Residents and ‘General ncoma Tax and Baneft Gude for Non esters end Deemed ‘Resins of Canada fr mare ntormaton on how port your come. ‘Box 18- Gross income - Tis is you old age security penson Enter this ‘amount on ine 113 of your Section 217 came tax ret and You" OW Age Secuny Ratu of income. [Box 17- Nonresident tax withheld - Ents tis amount on line 27 of your Secion 217 Income tax tun Box 27- Recovery tax withheld - Ener his amount on ine 47 of your (Oud Age Secunty Fetun of Income, Note: you area recent of Canad fr income tax purposes, report this ‘nome and te wate on your noone tax tun forte rowncs o erony hore you tved on December 31 ‘ch ta copy your Ot Age Sac Rar ot income soignez coms cpl vere carat de reve pour Sac Gala sass covets toe eco dre ee Sea Canada olges cate copie vetre Dolan des revenus pour Sécurité de Taos. Consutez vote guide Déclaraton des venus pour a Sécurité de la wiellosse pour les non ésisents ot vore Guide general aimpdt ot de rosa pour le nrereidonts ot résigents eputss Gu Canada ‘our en savow pus sul fapon de délarer ve raven. (Case 16 Revenu brut - Ceci est var pension ea Sécunt ea etlasea Insziver co montana la hype 118 devote ‘declaration selon arice 217 et vere Décuation dee ‘evens pour a Séeurid de a velosso. (Cave 17- mpot des non-residents retent Inscivez ce montant la \gne «37 oe yore dctaraton solo Fartcte 217 case 27- mpét eeu Inscrvez oe ontant ka 437 de vous Dlcaraion des evens pouria Secute inwetesse pee Remarque /S vous es un sient 6 Canada pour ies besoins de amp sue rever, nserver os revnu et mek elon cans wove aration Ge evens pour la prone ou toe ou vous resde2 Se St abcontre