Canada Revenue Agence du revenu Protected B when completed

Agency du Canada

Income Tax and Benefit Return

T1 2021

If this return is for a deceased person, enter their information on this page.
Attach to your paper return only the documents that are requested to support your deduction, claim or expense. Keep all other
documents in case the Canada Revenue Agency (CRA) asks to see them later. See the guide for more information about
supporting documents.

Step 1 – Identification and other information

MB 7
Identification
Social insurance Marital status on
First name Last name number (SIN) December 31, 2021:
KAREN PATRICIA PEREIRA SANCHEZ 671 966 265 1 X Married
Mailing address Date of birth 2 Living common-law
420 3RD STREET (Year Month Day)
PO Box RR 1984-11-15 3 Widowed
If this return is for 4 Divorced
a deceased person,
City Prov./Terr. Postal code 5 Separated
enter the date of death
BRANDON MB R7A 3C4 (Year Month Day) 6 Single
Email Address

By providing an email address, you are registering to receive

email notifications from the CRA and agree to the Terms of Your language of correspondence : X English
use in Step 1 of the guide. Votre langue de correspondance : Français

Residence Information
Your province or territory of residence on December 31, 2021: If you became a resident of Canada
Manitoba in 2021 for income tax purposes, (Month Day)
enter your date of entry:
Your current province or territory of residence if it is different than
your mailing address above:
If you ceased to be a resident
of Canada in 2021 for income
Province or territory where your business had a permanent tax purposes, enter your (Month Day)
establishment if you were self-employed in 2021: date of departure:

Your spouse's or common-law partner's information

Their first name Their SIN

VICTOR 671 880 805

Tick this box if they were self-employed in 2021. 1 X

Net income from line 23600 of their return to claim certain credits (even if the amount is "0") 21,998 32
Amount of universal child care benefit (UCCB) from line 11700 of their return
Amount of UCCB repayment from line 21300 of their return

Do not use this area

Do not use
this area
17200 17100
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 Protected B when completed

Step 1 - Identification and other information - (continued)

Elections Canada
For more information, see "Elections Canada" in Step 1 of the guide.

A) Do you have Canadian citizenship?

If yes, go to question B. If no, skip question B. 1 Yes 2 X No
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 or, if you are 14 to 17 years of age, the Register of Future Electors? 1 Yes 2 X No
Your authorization is valid until you file your next tax return. Your information will only be used for purposes permitted
under the Canada Elections Act, which include sharing lists of electors produced from the National Register of Electors
with provincial and territorial electoral agencies, members of Parliament, registered and eligible political parties, and
candidates at election time.
Your information in the Register of Future Electors will be included in the National Register of Electors once you turn 18 and your eligibility to vote is
confirmed. Information from the Register of Future Electors can be shared only with provincial and territorial electoral agencies that are allowed to collect
future elector information. In addition, Elections Canada can use information in the Register of Future Electors to provide youth with educational
information about the electoral process.

Indian Act – Exempt income

Tick this box if you have income that is exempt under the Indian Act.
For more information about this type of income, go to canada.ca/taxes-indigenous-peoples. 1
If you ticked the box above, complete Form T90, Income Exempt from Tax under the Indian Act, so that the CRA can
calculate your Canada workers benefit for the 2021 tax year, if applicable, and your family’s provincial or territorial benefits.
The information you provide on Form T90 will also be used to calculate your Canada training credit limit for the 2022 tax year.

Foreign property

Did you own or hold specified foreign property where the total cost amount of all such property,
at any time in 2021, was more than CAN$100,000? 26600 1 Yes 2 X No
If yes, complete Form T1135, Foreign Income Verification Statement. There are substantial penalties for not filing
Form T1135 by the due date. For more information, see Form T1135.

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Protected B when completed

Complete only the lines that apply to you, unless stated otherwise. You can find more information about the lines on this return
by calling 1-800-959-8281 or by going to canada.ca/line-xxxxx and replacing "xxxxx" with any 5-digit line number from this
return. For example, go to canada.ca/line-10100 for information about line 10100.

Step 2 - Total income

As a resident of Canada, you need to report your income from all sources inside and outside Canada.
Employment income (box 14 of all T4 slips) 10100 1
Tax-exempt income for emergency services volunteers
(See line 10100 of the guide) 10105
Commissions included on line 10100 (box 42 of all T4 slips) 10120
Wage-loss replacement contributions (See line 10100 of the guide) 10130
Other employment income (see line 10400 of the guide) 10400 2
Old age security (OAS) pension (box 18 of the T4A(OAS) slip) 11300 3
CPP or QPP benefits (box 20 of the T4A(P) slip) 11400 4
Disability benefits included on line 11400 (box 16 of the T4A(P) slip) 11410
Other pensions and superannuation (see line 11500 of the guide and line 31400 of the return) 11500 5
Elected split-pension amount (Complete Form T1032) 11600 6
Universal child care benefit (UCCB) (see the RC62 slip) 11700 7
UCCB amount designated to a dependant 11701
Employment insurance and other benefits (box 14 of the T4E slip) 11900 8
Employment insurance maternity and parental benefits, and
provincial parental insurance plan benefits 11905
Taxable amount of dividends from taxable Canadian corporations (use Federal Worksheet):
Amount of dividends (eligible and other than eligible) 12000 9
Amount of dividends (other than eligible) 12010
Interest and other investment income (use Federal Worksheet) 12100 10
Net partnership income (limited or non-active partners only) 12200 11
Registered disability savings plan income (box 131 of the T4A slip) 12500 12
Rental income (see Guide T4036) Gross 12599 Net 12600 13
Taxable capital gains (complete Schedule 3) 12700 14
Support payments received (see Guide P102) Total 12799 Taxable amount 12800 15
Registered retirement savings plan (RRSP) income (from all T4RSP slips) 12900 16
Other income (specify) : 13000 17
Taxable scholarships, fellowships, bursaries, and artists' project grants 13010 18
Add lines 1 to 18. 19
Self-employment income (see Guide T4002) :
Business income Gross 13499 Net 13500 20
Professional income Gross 13699 Net 13700 21
Commission income Gross 13899 Net 13900 22
Farming income Gross 14099 Net 14100 23
Fishing income Gross 14299 Net 14300 24
Add lines 20 to 24. Net self-employment income 0 00 25
Line 19 plus line 25 26
Workers' compensation benefits (box 10 of the T5007 slip) 14400 27
Social assistance payments 14500 28
Net federal supplements paid (box 21 of the T4A(OAS) slip) 14600 29
Add lines 27 to 29 (see line 25000 in Step 4). 14700 30
Line 26 plus line 30 Total income 15000 0 00 31

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Protected B when completed
Step 3 - Net income
Enter the amount from line 31 of the previous page. 0 00 32
Pension adjustment
(box 52 of all T4 slips and box 034 of all T4A slips) 20600
Registered pension plan (RPP) deduction
(box 20 of all T4 slips and box 032 of all T4A slips) 20700 33
RRSP deduction (see Schedule 7 and attach receipts) 20800 34
Pooled registered pension plan (PRPP) employer contributions
(amount from your PRPP contribution receipts) 20810
Deduction for elected split-pension amount (complete Form T1032) 21000 35
Annual union, professional, or like dues (receipts and box 44 of all T4 slips) 21200 36
Universal child care benefit repayment (box 12 of all RC62 slips) 21300 37
Child care expenses (complete Form T778) 21400 38
Disability supports deduction (complete Form T929) 21500 39
Business investment loss (see Guide T4037)
Gross 21699 Allowable deduction 21700 40
Moving expenses (complete Form T1-M) 21900 41
Support payments made (see Guide P102)
Total 21999 Allowable deduction 22000 42
Carrying charges, interest expenses, and other expenses
(use Federal Worksheet) 22100 43
Deduction for CPP or QPP contributions on self-employment income and
other earnings (complete Schedule 8 or Form RC381, whichever applies) 22200 44
Deduction for CPP or QPP enhanced contributions on employment income
(complete Schedule 8 or Form RC381, whichever applies) (maximum $290.50) 22215 45
Exploration and development expenses (complete Form T1229) 22400 46
Other employment expenses (see Guide T4044) 22900 47
Clergy residence deduction (complete Form T1223) 23100 48
Other deductions (specify): 23200 49
Federal COVID-19 benefits repayment (box 201 of all federal T4A slips) 23210 50
Add lines 33 to 50. 23300 51
Line 32 minus line 51 (if negative, enter "0") Net income before adjustments 23400 52
Social benefits repayment (including old age security benefits repayment, employment insurance
benefits repayment, and Canada recovery benefit repayment):
See the repayment chart on the back of your T4E slip if you entered an amount on line 11900 and
the amount on line 23400 is more than $70,375.
Use your Federal Worksheet if you entered an amount on line 11300 or line 14600 and the amount
on line 23400 is more than $79,845, or if you have an amount in box 202 of your T4A slip and the
amount on line 23400 is more than $38,000.
Otherwise, enter "0" on line 23500. 23500 53
Line 52 minus line 53 (if negative, enter "0")
(If this amount is negative, you may have a non-capital loss. See Form T1A.) Net income 23600 0 00 54

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Protected B when completed
Step 4 - Taxable income
Enter the amount from line 54 of the previous page. 0 00 55
Canadian Armed Forces personnel and police deduction
(box 43 of all T4 slips) 24400 56
Security options deductions (boxes 39 and 41 of T4 slips or see Form T1212) 24900 57
Other payments deduction (enter the amount from line 14700 if you did
not enter an amount on line 14600; otherwise, use Federal Worksheet) 25000 58
Limited partnership losses of other years 25100 59
Non-capital losses of other years 25200 60
Net capital losses of other years 25300 61
Capital gains deduction (Complete Form T657) 25400 62
Northern residents deductions (Complete Form T2222) 25500 63
Additional deductions (specify): 25600 64
Add lines 56 to 64. 25700 65
Line 55 minus line 65 (if negative, enter "0") Taxable income 26000 0 00 66

Step 5 – Federal tax

Part A – Federal tax on taxable income

Use the amount from line 26000 to complete the appropriate column below.
Line 26000 is Line 26000 is Line 26000 is
more more more
Line 26000 is than $49,020 than $98,040 than $151,978 Line 26000 is
$49,020 or but not more but not more but not more more than
less than $98,040 than $151,978 than $216,511 $216,511
Amount from line 26000 67
Line 67 minus line 68 - - 49,020 00 - 98,040 00 - 151,978 00 - 216,511 00 68
(cannot be negative) = 0 00 = = = = 69
Line 69 multiplied by the x 15 % x 20.5 % x 26 % x 29 % x 33 % 70
percentage from line 70 = = = = = 71
Line 71 plus line 72 + 0 00 + 7,353 00 + 17,402 10 + 31,425 98 + 50,140 55 72
Federal tax on
taxable income = = = = = 73
Enter the amount from line 73 on line 116 and continue at line 74.

Part B – Federal non-refundable tax credits

Basic personal amount:
If the amount on line 23600 is $151,978 or less, enter $13,808.
If the amount on line 23600 is $216,511 or more, enter $12,421.
Otherwise, use the Federal Worksheet to calculate the amount to enter. (maximum $13,808) 30000 13,808 00 74
Age amount (if you were born in 1956 or earlier)
(use Federal Worksheet) (maximum $7,713) 30100 75
Spouse or common-law partner amount (complete Schedule 5) 30300 76
Amount for an eligible dependant (complete Schedule 5) 30400 77
Canada caregiver amount for spouse or common-law partner, or eligible dependant age 18 or older
(complete Schedule 5) 30425 78
Canada caregiver amount for other infirm dependants age 18 or older (complete Schedule 5) 30450 79
Canada caregiver amount for infirm children under 18 years of age (see Schedule 5)
Number of children you are claiming this amount for 30499 x$ 2,295 = 30500 80
Add lines 74 to 80. 13,808 00 81

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Protected B when completed

Part B – Federal non-refundable tax credits (continued)

Enter the amount from line 81 of the previous page. 13,808 00 82
Base CPP or QPP contributions (complete Schedule 8 or Form RC381, whichever applies):
through employment income 30800 83
on self-employment income and other earnings 31000 84
Employment insurance premiums:
through employment
(boxes 18 and 55 of all T4 slips) (maximum $889.54) 31200 85
on self-employment and other eligible earnings
(complete Schedule 13) 31217 86
Volunteer firefighters' amount 31220 87
Search and rescue volunteers' amount 31240 88
Canada employment amount:
Enter whichever is less: $1,257 or line 1 plus line 2. 31260 89
Home buyers' amount (maximum $5,000) 31270 90
Home accessibility expenses (use Federal Worksheet) (maximum $10,000) 31285 91
Adoption expenses 31300 92
Digital news subscription expenses
(see line 31350 of the guide) (maximum $500) 31350 93
Add lines 83 to 93. 94
Pension income amount (use Federal Worksheet) (maximum $2,000) 31400 95
Add lines 82, 94, and 95. 13,808 00 96
Disability amount for self
(if you were under 18 years of age, use Federal Worksheet; if not, claim $8,662) 31600 97
Disability amount transferred from a dependant (use Federal Worksheet) 31800 98
Add lines 96 to 98. 13,808 00 99
Interest paid on your student loans (See Guide P105) 31900 100
Your tuition, education, and textbook amounts (Complete Schedule 11) 32300 101
Tuition amount transferred from a child or grandchild 32400 102
Amounts transferred from your spouse or common-law partner (Complete Schedule 2) 32600 103
Add lines 99 to 103. 13,808 00 104
Medical expenses for self, spouse or common-law partner,
and your dependent children born in 2004 or later 33099 105
Amount from line 23600 x 3% = 106
Enter whichever is less: $2,421 or the amount from line 106. 107
Line 105 minus line 107 (if negative, enter "0") 108
Allowable amount of medical expenses for other dependants
(use Federal Worksheet) 33199 109
Line 108 plus line 109 33200 110
Line 104 plus line 110 33500 13,808 00 111
Federal non-refundable tax credit rate 15 % 112
Line 111 multiplied by the percentage from line 112 33800 2,071 20 113
Donations and gifts (complete Schedule 9) 34900 114
Line 113 plus line 114 Total federal non-refundable tax credits 35000 2,071 20 115

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Protected B when completed

Part C - Net federal tax

Enter the amount from line 73. 116
Federal tax on split income (Complete Form T1206) 40424 117
Line 116 plus line 117 40400 118
Amount from line 35000 2,071 20 119
Federal dividend tax credit (use Federal Worksheet) 40425 120
Minimum tax carryover (Complete Form T691) 40427 121
Add lines 119 to 121. (if negative, enter "0") 2,071 20 2,071 20 122
Line 118 minus line 122. Basic federal tax 42900 123
Federal surtax on income earned outside Canada (complete Form T2203) 124
Line 123 plus line 124 125
Federal foreign tax credit (Complete Form T2209.) 40500 126
Line 125 minus line 126 0 00 127
Recapture of investment tax credit (complete Form T2038(IND)) 0 00 128
Line 127 plus line 128 0 00 129
Federal logging tax credit (see guide) 0 00 130
Line 129 minus line 130 (if negative, enter "0") Federal tax 40600 0 00 131
Federal political contribution tax credit (use Federal Worksheet)
Total federal political contributions
(attach receipts) 40900 (maximum $650) 41000 132
Investment tax credit (Complete Form T2038(IND)) 41200 133
Labour-sponsored funds tax credit (see line 41400 of the guide)
Net cost of shares of a provincially
registered fund 41300 Allowable credit 41400 134
Add lines 132 to 134. 41600 135
Line 131 minus line 135 (if negative, enter "0") 41700 136
Canada workers benefit advance payments received (box 10 of the RC210 slip) 41500 137
Special taxes (See line 41800 of the guide) 41800 138
Add lines 136 to 138. Net federal tax 42000 0 00 139

Step 6 - Refund or balance owing

Amount from line 42000 0 00 140
CPP contributions payable on self-employment income and other earnings
(complete Schedule 8 or Form RC381, whichever applies) 42100 141
Employment insurance premiums payable on self-employment and other eligible earnings
(Complete Schedule 13) 42120 142
Social benefits repayment (amount from line 23500) 42200 143
Provincial or territorial tax
(complete and attach your provincial or territorial Form 428, even if the result is "0") 42800 144
Add lines 140 to 144. Total payable 43500 0 00 145

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Protected B when completed

Step 6 - Refund or balance owing (continued)

Enter the amount from line 145 of the previous page. 0 00 146
Total income tax deducted (amounts from all Canadian slips) 43700 147
Refundable Quebec abatement (See line 44000 of the guide) 44000 148
CPP or QPP overpayment (See line 30800 of the guide) 44800 149
Employment insurance overpayment (See line 45000 of the guide) 45000 150
Refundable medical expense supplement (use Federal Worksheet) 45200 151
Canada workers benefit (CWB) (Complete Schedule 6) 45300 152
Canada training credit (CTC) (Complete Schedule 11) 45350 153
Refund of investment tax credit (Complete Form T2038(IND)) 45400 154
Part XII.2 tax credit
(box 38 of all T3 slips and box 209 of all T5013 slips) 45600 155
Employee and partner GST/HST rebate (Complete Form GST370) 45700 156
Eligible educator school supply tax credit
Supplies expenses (maximum $1,000) 46800 X 25 00 % = 46900 157
Canadian journalism labour tax credit (box 236 of all T5013 slips) 47555 158
Other refundable credits (specify): 47556 158a
Tax paid by instalments 47600 159
Provincial or territorial credits (Complete Form 479, if it applies) 47900 160
Add lines 147 to 160. Total credits 48200 161
Line 146 minus line 161
If the amount is negative, enter it on line 48400 below.
If the amount is positive, enter it on line 48500 below. Refund or balance owing 0 00 162
Generally, the CRA does not charge or refund a difference of $2 or less.

Refund 48400 Balance owing 48500

For more information and ways to enrol for direct deposit, Your balance owing is due no later than April 30, 2022.
go to canada.ca/cra-direct-deposit For more information on how to make your payment,
go to canada.ca/payments.

I certify that the information given on this return and in any If this return was completed by a tax professional, tick the
attached documents is correct, complete and fully discloses applicable box and provide the following information:
all of my income.
Was a fee charged? 49000 1 X Yes 2 No
Sign here
It is a serious offence to make a false return.
EFILE number (if applicable): 48900 D4712

Telephone number: (204) 717-8500 Name of tax professional: Allan Heise

Date: 2022-10-24 Telephone number:
(204) 729-5781
Personal information (including the SIN) is collected for the purposes of the administration or enforcement of the Income Tax Act and related programs and
activities including administering tax, benefits, audit, compliance, and collection. The information collected may be used or disclosed for purposes of other
federal acts that provide for the imposition and collection of a tax or duty. It may also be disclosed to other federal, provincial, territorial, or foreign government
institutions to the extent authorized by law. Failure to provide this information may result in interest payable, penalties, or other actions. Under the Privacy Act,
individuals have a right of protection, access to and correction of their personal information, or to file a complaint with the Privacy Commissioner of Canada
regarding the handling of their personal information. Refer to Personal Information Bank CRA PPU 005 on Info Source at canada.ca/cra-info-source.

Do not use 48600

48700 48800
this area

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Form MB428
Manitoba Tax 2021
Protected B when completed

Part A - Manitoba tax on taxable income

Enter your taxable income from line 26000 of your return. 1

Use the amount from line 1 to decide which column to complete.

Line 1 is more than
Line 1 is $33,723 but not Line 1 is
$33,723 or less more than $72,885 more than $72,885

Amount from line 1 2

0 00 33,723 00 72,885 00 3
Line 2 minus line 3 (cannot be negative) 4
x 10.80 % x 12.75 % x 17.40 % 5
Line 4 multiplied by the percentage from line 5 6
Line 6 plus line 7 0 00 3,642 08 8,635 24 7
Manitoba tax on taxable income 8
Enter the amount from line 8 on line 58 and continue on line 9.

Part B - Manitoba non-refundable tax credits

Internal use 56060
Basic personal amount claim $9,936 58040 9,936 00 9
Age amount (if you were 65 years of age or older) (use Worksheet MB428) (maximum $3,728) 58080 10
Spouse or common-law partner amount:
Base amount 9,134 00 11
Your spouse's or common-law partner's net income from line 23600 of their return - 21,998 32 12
Line 11 minus line 12 (if negative, enter "0") 58120 = + 13
Amount for an eligible dependant:
Base amount 9,134 00 14
Your eligible dependant's net income from line 23600 of their return - 15
Line 14 minus line 15 (if negative, enter "0") 58160 = + 16
Amount for infirm dependants age 18 or older (use Worksheet MB428) 58200 + 17
Add lines 9, 10, 13, 16, and 17. = 9,936 00 18
CPP or QPP contributions:
Amount from line 30800 of your return 58240 19
Amount from line 31000 of your return 58280 20
Employment insurance premiums:
Amount from line 31200 of your return 58300 21
Amount from line 31217 of your return 58305 22
Volunteer firefighters' amount 58315 23
Search and rescue volunteers' amount 58316 24
Fitness amount 58325 25
Children's arts amount 58326 26
Adoption expenses 58330 27
Add lines 19 to 27. = + 28
Line 18 plus line 28 = 9,936 00 29

9407-C E (20) (Ce formulaire est disponible en français.)

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Protected B when completed
Part B – Manitoba non-refundable tax credits (continued)
Amount from line 29 of the previous page 9,936 00 30
Pension income amount (maximum $1,000) 58360 31
Caregiver amount (use Worksheet MB428) 58400 32
Add lines 30 to 32. = 9,936 00 33
Disability amount for self
(claim $6,180, or if you were under 18 years of age, use Worksheet MB428.) 58440 34
Disability amount transferred from a dependant (use Worksheet MB428) 58480 35
Add lines 33 to 35. = 9,936 00 36
Interest paid on your student loans (amount from line 31900 of your return) 58520 37
Your tuition and education amounts (attach Schedule MB(S11)) 58560 38
Tuition and education amounts transferred from a child 58600 39
Amounts transferred from your spouse or common-law partner (attach Schedule MB(S2)) 58640 40
Family tax benefit (attach Schedule MB428-A) 61470 2,065 00 41
Add lines 36 to 41. = 12,001 00 42
Medical expenses:
Amount from line 33099 of your return 58689 43

Amount from line 23600 of your return 44

Applicable rate x 3 00 % 45
Line 44 multiplied by the percentage from line 45 = 46
Enter whichever is less: $1,728 or the amount from line 46. 47
Line 43 minus line 47 (if negative, enter "0") 48
Allowable amount of medical expenses for other dependants
(use Worksheet MB428) 58729 49
Line 48 plus line 49 58769 50
Line 42 plus line 50 58800 12,001 00 51
Manitoba non-refundable tax credit rate x 10.80 % 52
Line 51 multiplied by the percentage from line 52 58840 1,296 11 53
Donations and gifts:
Amount from line 13 of your federal Schedule 9 x 10.80 % = 54
Amount from line 14 of your federal Schedule 9 x 17.40 % = 55
Line 54 plus line 55 58969 0 00 56
Line 53 plus line 56
Enter this amount on line 61. Manitoba non-refundable tax credits 61500 1,296 11 57

9407-C E (20) (Ce formulaire est disponible en français.)

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Protected B when completed
Part C – Manitoba tax
Manitoba tax on taxable income from line 8 58
Manitoba tax on split income (complete Form T1206). 61510 59
Line 58 plus line 59 60
Manitoba non-refundable tax credits from line 57 1,296 11 61
Manitoba dividend tax credit (use Worksheet MB428) 61520 62
Manitoba minimum tax carry-over:
Amount from line 40427 of your return x 50.00 % = 61540 63
Add lines 61 to 63 1,296 11 1,296 11 64
Line 60 minus line 64 (if negative, enter "0") 0 00 65
Manitoba additional tax for minimum tax purposes:
Form T691: line 111 minus line 112 x 50.00 % = 66
Line 65 plus line 66 67

Manitoba political contributions made in 2021 61794 68

Manitoba political contribution tax credit (use Worksheet MB428) (maximum $1,000) - 69
Line 67 minus line 69 (if negative, enter "0") = 70
Enter your labour-sponsored funds tax credit from Slip T2C (MAN.) 60800 71
Line 70 minus line 71 (if negative, enter "0") 72
Provincial foreign tax credit (complete Form T2036) 73
Line 72 minus line 73 (if negative, enter "0") 74
Manitoba community enterprise development tax credit (complete Form T1256). 60830 75
Line 74 minus line 75 (if negative, enter "0") 76
Manitoba small business venture capital tax credit for individuals
(complete Form T1256-1) (maximum $120,000) 60850 77
Line 76 minus line 77 (if negative, enter "0") 78
Manitoba employee share purchase tax credit (complete Form T1256-2) 60860 79
Line 78 minus line 79 (if negative, enter "0") 80
Manitoba mineral exploration tax credit (complete Form T1241). 60920 81
Line 80 minus line 81 (if negative, enter "0")
Enter this amount on line 42800 of your return. Manitoba tax 0 00 82

9407-C E (20) (Ce formulaire est disponible en français.)

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Schedule MB428–A
Manitoba Family Tax Benefit 2021
Protected B when completed
Complete this schedule to claim the family tax benefit. Attach a copy of this schedule to your return.
Basic amount 2,065 00 1
Amount for dependent spouse or common-law partner claimed on line 58120 of
your Form MB428 Claim $2,065 + 2
Amount for an eligible dependant claimed on line 58160 of Form MB428 Claim $2,065 + 3
Age amount for self if you were 65 years of age or older Claim $2,065 + 4
Age amount for spouse or common-law partner who is 65 years of age or older Claim $2,065 60700 + 5
Disability amount for spouse or common-law partner Claim $2,752 60710 + 6
Disability amount for self or for a dependant other than your spouse or common-law partner
Number of disability claims 60720 x $2,752 = + 7
Amount for disabled dependants born in 2003 or earlier
Number of disabled dependants 60740 x $2,752 = + 8
Amount for dependent children born in 2003 or later (complete chart below)
Number of dependant children 60760 x $2,752 = + 9
Add lines 1 to 9. = 2,065 00 10
Enter your net income from line 23600 of your return. x 9.00 % = - 11
Line 10 minus line 11 (if negative, enter "0")
Enter this amount on line 61470 of Form MB428. Family tax benefit = 2,065 00 12

Details of dependent children born in 2003 or later (if you need more space, attach a separate sheet of paper)
Social insurance number
Child's name Relationship to you Child's date of birth
(if available)
JAILENE RAPALO Daughter 2008-07-07 ___ ___ ___
NATHALIE RAPALO Daughter 2013-03-08 ___ ___ ___
VICTORIA RAPALO Daughter 2016-04-24 ___ ___ ___
See the privacy notice on your return.

See the privacy notice on your return.

9407-C E (21) (Ce formulaire est disponible en français.)
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Client: PEREIRA SANCHEZ, KAREN PATRICIA SIN: 671 966 265 Printed: 2022/10/24 13:56
CCB
Canada Child Benefit
Are you eligible to receive the Canada Child Benefit? Yes X No

Qualified dependants
Child Disability
Name Birthdate Shared Custody Basic benefit Benefit
Supplement
JAILENE RAPALO 2008-07-07 No 5,903.00
NATHALIE RAPALO 2013-03-08 No 5,903.00
VICTORIA RAPALO 2016-04-24 No 5,903.00
Subtotal 17,709.00
Totals 17,709.00

Number of eligible
Number of eligible Number of eligible Number of eligible
Number of eligible children between
Payment month children under 6 children between children with a
children under 6 6 and 17
under shared custody 6 and 17 disability
under shared custody
July - 2022 3
August 3
September 3
October 3
November 3
December 3
January - 2023 3
February 3
March 3
April 3
May 3
June 3

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Client: PEREIRA SANCHEZ, KAREN PATRICIA SIN: 671 966 265 Printed: 2022/10/24 13:56
CCB
Canada Child Benefit
Calculation of benefits for July 2022 to June 2023
Basic benefit 17,709.00 1
Benefit reduction:

Taxpayer's 2021 adjusted net income 2

Spouse's 2021 adjusted net income 21,998.32 3
Total family adjusted net income (Line 2 + Line 3) Subtotal 21,998.32 4
Less: Universal Child Care Benefit (UCCB) 5
Universal Child Care Benefit repayment 6
Less: Registered Disability Savings Plan (RDSP) income 7
Registered Disability Savings Plan repayment 8
2021 family adjusted net income 21,998.32 9
First Phase-out amount for reduction 32,797.00 10
Income over first phase-out amount (maximum $38,263) (Line 9 - Line 10) 11
Reduction % 12
First Phase-out Reduction amount (Line 11 x Line 12) 13
Second Phase-out amount for reduction (maximum $71,060) 71,060.00 14
Income over the second phase-out amount (Line 9 - Line 14) 15
Reduction % 16
Second Phase-out Reduction amount (Line 15 x Line 16) + + 17
Total reduction (Line 13 + Line 17) = = 18
Estimated Canada Child Benefit Amount (Line 1 - Line 18) + 17,709.00 + 19
Child Disability Benefit supplement
Basic benefit 20
Benefit reduction:
2021 family adjusted net income 21,998.32 21
Phase-out amount for reduction 71,060.00 22
Excess amount over phase out amount (Line 21 - Line 22) 23
Reduction % 24
Reduction Amount (Line 23 x Line 24) - - 25
Subtotal + + 26

Total benefit (Line 19 + Line 26) 17,709.00 27

Amount from Line 27 17,709.00 28
Estimated Canada Child Benefit for July 2022 to June 2023
- if less than $240, amount is payable as a lump sum in July 2021 (Line 28 + 29a) 17,709.00 30

ESTIMATED Monthly Canada Child Benefit 1,475.75 31

This worksheet is for information purposes only.

The calculation of these benefits is an estimate based on the federal and provincial legislation
available to us. Canada Revenue Agency will calculate the actual benefits, which may differ from
this estimate.

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