ARCHIVED CD 2000-029: Appendix A

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APPENDIX A

SAMPLE LETTER FROM DEPARTMENT TO RESIDENTS OF QUÉBEC TO REPORT INFORMATION CONCERNING RETROACTIVE LUMP SUM PAYMENTS THAT MAY QUALIFY FOR A QUÉBEC INCOME TAX RECALCULATION

TO: Ministère du Revenu du Québec (MRQ)

EMPLOYEE NAME:

Social Insurance Number (SIN) :

SUBJECT: Retroactive Lump Sum Payments that may qualify for a Québec Income Tax recalculation

YEAR IN WHICH PAYMENT WAS ISSUED:

TOTAL AMOUNT OF THE RETROACTIVE PAYMENT:

DESCRIPTION/TYPE OF PAYMENT:

Breakdown of principal by year

Amount related to year __________ : $__________

Amount related to year __________ : $__________

Amount related to year __________ : $__________

Amount related to year __________ : $__________

Amount related to year __________ : $__________

Breakdown of interest by year (if applicable)

Amount related to year __________ : $__________

Amount related to year __________ : $__________

Amount related to year __________ : $__________

Amount related to year __________ : $__________

Amount related to year __________ : $__________

DATE:
SIGNATURE OF COMPENSATION ADVISOR:
TELEPHONE NUMBER: