Primary Caregiver Tax Credit Form - The Manitoba Tax Assistance Office

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Primary Caregiver’s Log
Primary Caregiver Tax Credit
Tax year:
_______________
Full name of caregiver:
_______________________________________________________________________________
Full name of care recipient: _________________________________________________________________________________
Start date: date you started providing care to this client or
October 1 of the previous year, whichever is later
Types of care you personally provide to this client (list), including approximate frequency for each:
End date: If you stopped providing care enter date; indicate reason below.
Reason for end of caregiving (check one or more):
client deceased or moved out of Manitoba
■ ■
client moved away from caregiver’s area or caregiver moved away from client’s area
■ ■
client moved to a different RHA
■ ■
client moved to a personal care home or other care institution
■ ■
client stopped requiring care at Level 2 or higher
■ ■
client designated another caregiver as primary caregiver for tax credit purposes
■ ■
other (specify) ________________________________________________________________________________________
■ ■
Temporary interruptions in caregiving lasting 15 consecutive days or longer
Interruption
Date care
Total days of
Reason for interruption
start date
resumed
this interruption
(ex: vacation, hospital stay, etc.)
Total days of interruption:
Please attach additional sheets if more space is required.
First year claim (claim A or B) – Number of days care was provided to this care recipient:
A. If you started providing care prior to October 1 of the previous year, deduct the total interruption days from the
number of days in the current tax year.
_____________________1.
B. If you started providing care after October 1 of the previous year, deduct 90 days from the total of the days from
your start date to December 31 of the current tax year. From this total, deduct the total interruption days in the
current year. ______________________2.
or
Subsequent year claim – Number of days care was provided to this care recipient:
Number of days in the current tax year minus the total days of interruption. ______________________3.
Enter 1, 2 or 3 on the appropriate line on form MB479 of your income tax return.
Declaration: I have maintained this log continuously during the period I provided care, and certify that it is true in all
particulars to the best of my knowledge and belief. I understand it is an offence under The Income Tax Act to provide
incorrect information.
Signature of caregiver____________________________________________________ Date ____________________________

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