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1 and Revenue Agency et du revenu du Canad
and Revenue Agency et du revenu du CanadaT1164 E (99) Confidential information NISA Account Information and If you have more than one farming operation (a sole proprietorship and one or moreFarming Activities for Individuals, General information $ Line Total Amount commodities and program payments Method of accounting: Address SDRM total from Statement C (line 9952), if Gravel Resales, rebates, GST/HST for eligible Patronage dividends Total A 9574 Identification (You must complete a Form T1164, Statement B, for each additional farming operation.) Income Enter the code that applies for each entry on the form. The codes are listed in the commodity list and the program payment list included in theFarming Income and NISA Code CultivatedPartnership Sole proprietorship Total area (complete the boxes that apply) Was 1999 your last year ofYearMonthDay YearDay OwnedorAcres $$ Resales, rebates, GST/HST for non-eligibleexpenses Agricultural contract work Interest 9605 9607 9610 9575 Total A Total B + Gross farming income (enter on line 9959 onpage 4 and on line 168 of your individual income YesNo Other farming income 9951 9950 Total C Farm name Sales Sales Summary of income Total C Trucking (farm-related only) Resales of commodities pu

2 rchased 9611 9612 Business Number Total
rchased 9611 9612 Business Number Total B Other (specify): Machine rental Leases (gas, oil well, surface, etc.) commodities and program payments 9613 9614 + 9600 Disaster assistance and program payments 9544 $ Expenses (enter on line 9968 on page 4) Enter the code that applies for each entry on the form. The codes are listed in the commodity list and theprogram payment list included in the guide called Farming Income and NISARound off all amounts to Total F SDRM total from Statement C, if applicable Total D Electricity Total $ Insurance premiums (crop) Containers and twine 9661 Storage/drying Statement B – page 3 9662 Agricultural contract work Minerals and salts Veterinary fees, medicine, A.I. fees Machinery (repairs, licences, insurance) Machinery (gasoline, diesel fuel, oil) Advertising and marketing costs Building and fence repairs Freight and trucking Heating fuel Other insurance premiums 9665 Motor vehicle expenses Memberships/subscription fees Salaries (other than spouse or dependants) Legal and accounting fees Office expenses Small tools Summary of expenses Total D $$$ + + + $ Licences/permits Soil testing 9960 Telephone Other (specify) 9713 9714 9760 9764 9792 9795 9798 9799 9801 9802 9804 9807 9808 9809 9815 9819 9820 9821 9822 9823 9897 9831 9663 Fertilizers and lime Pesticides Line Expenses NISA qualifying commodities and repayme

3 nt of program benefits Code Purchases NI
nt of program benefits Code Purchases NISA eligible expenses 50% of non-itemized invoices Freight deductions on grain ticket Prepared feed and protein supplements Total E 9961 NISA non-qualifying commodities and repayment of program benefits Code Purchases Land clearing and draining NISA non-eligible expenses Expenses Machinery lease/rental Line Interest (real estate, mortgage, other) Property taxes Rent (land, buildings, pastures) Gravel Quota rental (tobacco, dairy) Purchases of commodities resold Motor vehicle interest and leasing costs Allowance on eligible capital property (complete Form T1175) Total G 9765 Mandatory inventory adjustments/prior year Optional inventory adjustments/prior year Other (specify): 9796 9805 9810 9811 9825 9826 9827 9829 9935 9936 9937 9938 9896 Total E Total G Total F 046 9830 Prepared feed (35% of non-itemized invoices) 9824 Salaries paid to spouse 9828 9816 Salaries paid to dependants Summary of income and expenses If you have multiple operations, or additional expenses that apply to partnerships, add the amounts from line 9946 of the– NISA Account Information and Statement of Farming ActivitiesStatement B – NISA Account Information and Statement of Farming Activities for Additional Farming Operations Enter the total on line 141 of your individual income tax return. Your share of line a (enter the dollar amount) Adjustment to business-use-of-ho

4 me expense (from Area B on Form T1175, i
me expense (from Area B on Form T1175, if it applies.) after adjustments (enter amount a Partnership information (if applicable) 9944 9934+=b – current year (if applicable) Total – Expenses (enter total from "Summary of expenses" on page 3) Gross farming income (enter total from "Summary of income" on page 2) 9969 9959 9968 Other additions (see line 9939 in the guide) Net income (loss) before adjustments (line 9959 minus line 9968) Other deductions (see line 9940 in the guide) Optional inventory adjustment – current year (if applicable) 9939 9942a 9940 9941–+==+–Add:Minus: +Add:= 9946 See note below. (Enter this amount on line 141 of your individualincome tax return) Subtotal Statement B – page 4 Amount Other information 9966 9965 9964 Your spouse's net income as reported on line 236 of the individual tax return Taxable gain resulting from a foreclosure or forced sale of farm land Taxable gain resulting from a foreclosure or forced sale of farm land – spouse Partnership information Partnershipidentification number Partner's name Partner's name Partner's name Partner's name Partner's name Your name Social insurance number or Business Number if partner is a corporation %%%% Partnership name Enter the first and last name if the partner is an individual. Enter thecorporation name if the partner is a corporation. % sharePrinted in Canada Line Subtot