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  T1-2017 Statement of Investment Income Schedule 4  
   
  State the names of the payers below, and attach any information slips you received. Attach a separate sheet of  
  paper if you need more space. Attach a copy of this schedule to your return.  
   
   I – Taxable amount of dividends (eligible and other than eligible) from taxable Canadian corporations  
  Taxable amount of dividends other than eligible dividends (specify):   1  
    + 2  
    + 3  
  Add lines 1 to 3, and enter this amount on line 180 of your return. 180 = 4  
  Taxable amount of eligible dividends (specify):   + 5  
    + 6  
    + 7  
  Add lines 4 to 7, and enter this amount on line 120 of your return. 120 = 8  
         
   
   II – Interest and other investment income  
  Specify:   9  
    + 10  
  Income from foreign sources (specify):   + 11  
  Add lines 9 to 11. Enter this amount on line 121 of your return. 121 = 12  
         
   
   III – Carrying charges and interest expenses  
  Carrying charges (specify):   13  
  Interest expenses (specify):   + 14  
  Add lines 13 and 14. Enter this amount on line 221 of your return. 221 = 15  
         
  5000-S4 See the privacy notice on your return.