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Protected B when completed
Environmental Trust Income Tax Return
  Do not use this area.
Complete this return for a qualifying environmental trust, as defined on page 2 of this return.  
You are required to complete a Schedule 15, Beneficial Ownership Information of a Trust and send it with this return.  
Send one completed T3M return, along with any payment owing and the required financial statements, no later than
90 days after the end of the tax year. If you do not file this return on time, we will charge penalties and interest on
any amount owing.
Identification and other information
 Residence of the trust at the end of the tax year, enter the province or territory  
Tax year   
 Name of trust Trust account number
Trustee information
Enter only the information of the trustee that is the CRA's primary contact. Do not enter information for any other trustees.
 Name of trustee (For example, the crown or a trust company)
 First name of contact person  Last name of contact person  Telephone number
 Address City Province/Territory or State Country  Postal or ZIP code
If the mailing address of the trust is different from the address above, fill in this section.
 Care of (C/O)  Telephone number
 Address City Province/Territory or State Country  Postal or ZIP code
Information about the trust
 Province of qualifying site Your language of correspondence:
English  French 
 Type of trust:
509 Mining reclamation 510  Waste disposal reclamation 511 Quarry reclamation 512 Pipeline reclamation
  If this is the final return of the trust, give the date the trust wound up
 Date trust was created   or is planning to wind up.
  Year Month Day    
Is this the first year the trust is filing a tax return? Yes
    Year Month Day  
  Number of beneficiaries under the trust    
  Total amount of contributions made to the trust in the year   $  
  Total amounts withdrawn from the trust in the year   $  
T3M E (23) (Ce formulaire est disponible en français.) Page 1 of 2 Canada Logo

Protected B when completed
Income and tax payable
  Income subject to tax (send us financial statements)   295    1
  Tax under Part XII.4   (line 1   x 15% ) =   175   •2
  Provincial tax on income subject to tax (see Note)   (line 1   x % ) =   176   + •3
  Total tax payable (line 2 plus line 3)   190   = •4
  Minus: Payments on account   010   •5
  Balance owing or refund (line 4 minus line 5)   090   = •6
If the result is positive, you have a balance owing. If the result is negative, you have a refund.  
Generally, we do not charge or refund a difference of $2 or less.  
Amount enclosed   095   •7
Refund code    102    8
(see the guide for details)  
  Balance owing: Pay a balance owing online using CRA’s My Payment service at canada.ca/cra-my-payment. You can also
send us a cheque or money order payable to the Receiver General. Do not mail cash.
  Refund: To receive a refund by direct deposit, complete Form T3-DD, Direct Deposit Request for T3.
  Note: The British Columbia tax rate is 12%, the Alberta tax rate is 8%, the Ontario tax rate is 11.5% and the Saskatchewan tax rate is 12%.
I,  , certify that the information given on this return and in any attached documents is correct, complete and
(Print name)   fully discloses all of my income.
  Signature of trustee or trust company official Position or office if trustee is a corporation Telephone number Date YYYYMMDD
How to file this return
  By internet By mail
  You have the option to file this return through EFILE.
For more information about this filing method, go to canada.ca/efile.
Sudbury Tax Centre
T3 Trust Returns Program
Canada Revenue Agency
1050 Notre Dame Avenue
Sudbury ON P3A 6C2
Information and instructions
•  Unless otherwise stated, each legislative reference in this return is to the Income Tax Act.
•  Subsection 211.6(1) defines a qualifying environmental trust (QET) as a trust that is maintained for the sole purpose of funding the reclamation of a
qualifying site in Canada used primarily for one or more of the following: the operation of a mine, the extraction of clay, peat, sand, shale or
aggregates (including dimension stone and gravel), the deposit of waste, or if the trust was created after 2011, the operation of a pipeline, as long as
the other requirements defined in subsection 211.6(1) are met. Under the definition, the trust is, or may become, required to be maintained under
the terms of a qualifying contract or a qualifying law as these terms are defined in subsection 211.6(1). Certain conditions exist that may exclude a
trust from being a QET.
•  A QET is exempt from tax under Part I.
•  An Environmental Quality Act trust described by paragraph 149(1)(z.1) of the Act was created because of a requirement imposed by section 56 of
the Environment Quality Act. A Nuclear Fuel Waste Act trust described by paragraph 149(1)(z.2) of the Act was created because of a requirement
imposed by subsection 9(1) of the Nuclear Fuel Waste Act. These trusts are exempt from tax under Part XII.4.
•  With the exception of Quebec tax, use this return to calculate tax payable under the provincial income tax legislation that applies.
For a QET resident in Quebec, refer to the website of the Revenu Quebec.
•  Calculate the trust's income without considering subsections 104(4) to (31) and sections 105 to 107.
•  Any income or loss the trust earns or realizes in a taxation year is considered to also be earned or realized by the beneficiaries of the trust.
Beneficiaries are entitled to a refundable federal tax credit for their share of the Part XII.4 tax payable by the trust. If provincial tax is payable by the
trust to Alberta, British Columbia, Saskatchewan or Ontario, beneficiaries may also be entitled to a refundable provincial tax credit for their share of
the provincial tax payable by the trust.
•  In a letter or statement, report to the beneficiaries the income, losses, credits, or withdrawals. Specify, in each letter or statement, the refundable
provincial tax credit and the province to which it applies, the refundable federal tax credit, net capital losses, capital gains, non-capital losses, and
other income for each beneficiary.
•  The tax year of a QET is the calendar year.
Personal information (including the SIN) is collected and used to administer or enforce the Income Tax Act and related programs and activities including administering tax, benefits, audit,
compliance, and collection. The information collected may be disclosed to other federal, provincial, territorial, aboriginal or foreign government institutions to the extent authorized by law.
Failure to provide this information may result in paying interest or penalties, or in 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 015 on Information about Programs and Information Holdings at canada.ca/cra-information-about-programs.
T3M E (23) Page 2 of 2