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T1 GENERAL 2010 Income Tax and Benefit Return for Non-residents and Deemed Residents of Canada Identification Information about you Attach your personal label here. Correct any wrong information* If you are not attaching a label print your name and address below. First name and initial Enter your social insurance number SIN temporary tax number TTN or individual tax number ITN if you are not attaching a label Year Day Month Enter your date of birth Last name Your language of correspondence Votre langue de correspondance Mailing address Apt No Street No Street name PO Box Prov*/Terr. Fran ais Tick the box that applies to your marital status on December 31 2010 see the Marital status section in the guide RR City English Postal code Married Divorced Living common-law Separated Widowed Single common-law partner if you ticked box 1 or 2 above see the guide for more information Country Enter his or her SIN TTN or ITN if it is not on the label or if you are not attaching a label Enter your province or territory of residence on December 31 2010 Other 2010 to claim certain credits Enter the amount of Universal Child Care Benefit included on line 117 of his or her return Your country of residence on December 31 2010 included on line 213 of his or her return If you were self-employed in 2010 enter the province or territory of self-employment Tick this box if he or she was self-employed in 2010 Person deceased in 2010 If this return is for a deceased person enter the date of death Do not use this area Elections Canada see the Elections Canada page in the tax guide for details or visit www. elections. ca A Are you a Canadian citizen. Yes 1 No Answer the following question only if you are a Canadian citizen* B As a Canadian citizen do you authorize the Canada Revenue Agency to give your name address date of birth and citizenship to Elections Canada to update the National Register of Electors. Yes Your authorization is valid until you file your next return* Your information will only be used for purposes permitted under the Canada Elections Act which includes sharing the information with provincial/territorial election agencies Members of Parliament and registered political parties as well as candidates at election time. Goods and services tax/harmonized sales tax GST/HST credit application Deemed residents only see the guide for details. Are you applying for the GST/HST credit. Yes No Yes I was a non-resident of Canada. I was a deemed non-resident of Canada. I was a deemed resident of Canada because I stayed in Canada for 183 days or more in 2010. Do not use this area 5013-R The guide contains valuable information to help you complete your return* When you come to a line on the return that applies to you look up the line number in the guide for more information* If you were a deemed resident of Canada in 2010 please answer the following question Did you own or hold foreign property at any time in 2010 with a total cost of more than CAN 100 000 see the Foreign income section in the guide for details.

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