AgriInvest - 2021 Statement A – Corporation/Co-operative and Special Individual

Protected B when complete

Participant information

Participant indentification

• First Name/Entity name
• Last Name
• Address
• City/Town
• Province/Territory
• Postal code
• Telephone number
• Fax number
• Email address
• Participant Identification Number (PIN)
• Note: You must enter your PIN unless you have not been assigned one.
• Social Insurance Number (SIN)
• Business number
• Trust number
• Band number
• Language of preference: (English/French)

Contact person information

If you would like someone else to provide additional information on your behalf, provide all details in this section. This applies only to the AgriStability and AgriInvest programs.

• If you have a contact person check here
• First name
• Last name
• Business name
• Address
• City/Town
• Province/Territory
• Postal code
• Telephone number
• Fax number

Do you want a copy of your Calculation of Program Benefits (COB) for the AgriStability program sent to your contact person? (Yes/No)

Note - If you have a contact person, you must complete this section each time you submit this form. The AgriStability and AgriInvest Administrations will replace any previous contact person you may have designated with the name you provide here.

By providing a contact person's name, you are authorizing both the AgriStability and AgriInvest Administrations to receive information from and to disclose information to the contact person, and to make changes to your applications as directed by the contact person.

Your farming information

• Province/Territory of main farmstead
• Number of years this operation has farmed
• Was 2021 your last year of farming? (Yes/No)
• Have you completed a production cycle on at least one of the commodities you produced? (Yes/No)
• If you checked "no" to the above question, were you unable to complete a production cycle due to disaster circumstances? (Yes/No)

Federal public office holder or employee of Agriculture and Agri-Food Canada

Are you, or anyone who participated in the preparation of this form on your behalf, a current or former federal public office holder or employee of Agriculture and Agri-Food Canada? (Yes/No)

Farm Type

(check all the applicable boxes)

• Corporation
  • Date of incorporation (Year/Month/Day)
• co-operative
• communal organization
• member of a partnership
• limited partnership
• Status Indian farming on a reserve
• Band farm
• Trust
• If this form is for a deceased person, enter the date of death. (Year/Month/Day)

Other farming information

Location of main farmstead, indicate your district, county or municipality name and number:

• Yukon and British Columbia - district
  New Brunswick and Nova Scotia - county
  Manitoba - municipality
  • district/county/municipality name:
  • district/county/municipality number:

Combined operations

Based on the AgriStability combining criteria outlined in the guide, should this operation be combined with another operation for the 2021 program year? (Yes/No)

Note: If your operations were combined in your last year of participation, you will automatically be combined for 2021, unless you answered “No” to the above question.

• If your operations should be combined in the 2021 program year, or were previously but should no longer be combined, indicate the PIN(s) that should be added or removed from your whole farm.
  • Add/Remove
  • Add/Remove
  • Add/Remove

Identification – Complete a Statement B for each additional farming operation

• Sole proprietorship/Partnership
  Note: If you indicate you are in a partnership, complete the partnership information section on page 4.
• Fiscal period
  • From: (Year/Month/Day)
  • To: (Year/Month/Day)
• Method of accounting
  • Enter Code 1: If you are using the accrual method to report for AgriStability and AgriInvest and to Canada Revenue Agency (CRA)
  • Enter Code 2: If you are using the cash method to report for AgriStability and AgriInvest and to CRA
• Was your farming operation involved in any of the following: (check all applicable boxes for this operation)
  • a member of a feeder association
  • a crop share (landlord)
  • a crop share (tenant)

Income

Enter the applicable code for each entry on the form. The codes are listed in the Commodity list and in the Program payment lists included in the AgriStability and AgriInvest Corporation, Co-operative and Special Individual Harmonized Guide.

Round all income amounts to the nearest dollar.

Commodity sales and program payments

Commodity sales and program payments	Code	Amount
Total A: Total of	9950	$

Other farming income

Other farming income	Line	Amount
Other program payments	9540
Business risk management (BRM) and disaster assistance program payments	9544
Resales, rebates, GST/HST for allowable expenses	9574
Resales, rebates, GST/HST for non-allowable expenses, recapture of capital cost allowance (CCA)	9575
Agricultural contract work	9601
Patronage dividends	9605
Interest	9607
Gravel	9610
Trucking (farm-related only)	9611
Resales of commodities purchased	9612
Leases (gas, oil well, surface, etc.)	9613
Machine rentals	9614
Other (specify):	9600
Total B: Total of other		$

Summary of income

Total A
Total B	+
Gross farming income: Total A plus Total B (enter on line 9959 on page 4)	$

Expenses

Enter the applicable code for each entry on the form. The codes are listed in the Commodity list and in the Program payment lists included in the AgriStability and AgriInvest Corporation, Co-operative and Special Individual Harmonized Guide.

Round all expense amounts to the nearest dollar.

Commodity purchases and repayment of program benefits

Commodity purchases and repayment of program benefits	Code	Amount
Point of sale adjustments	575
Total C: Total commodity	9960	$

Allowable expenses

Allowable expenses	Line	Amount
Containers and twine	9661
Fertilizers and soil supplements	9662
Pesticides and chemical treatments	9663
Insurance premiums (crop or production)	9665
Veterinary fees, medicine, and breeding fees	9713
Minerals and salts	9714
Machinery (gasoline, diesel fuel, oil)	9764
Electricity	9799
Freight and shipping	9801
Heating fuel	9802
Arm's length salaries	9815
Storage/drying	9822
Commissions and levies	9836
Private insurance premiums for allowable commodities	9953
Total D: Total of allowable		$

Non-allowable expenses

Non-allowable expenses	Line	Amount
Machinery (repairs, licences, insurance)	9760
Machinery lease/rental	9765
Advertising and promotion costs	9792
Building and fence repairs	9795
Land clearing and draining	9796
Agricultural contract work	9798
Other insurance premiums	9804
Interest (real estate, mortgage, other)	9805
Memberships/subscription fees	9807
Office expenses	9808
Legal and accounting fees	9809
Property taxes	9810
Rent (land, buildings, pastures)	9811
Non-arm's length salaries	9816
Motor vehicle expenses	9819
Small tools	9820
Soil testing	9821
Licenses/permits	9823
Telephone	9824
Quota rental (tobacco, dairy)	9825
Gravel	9826
Purchases of commodities resold	9827
Motor vehicle interest and leasing costs	9829
Capital cost allowance	9936
Mandatory inventory adjustments - prior year	9937
Optional inventory adjustments - prior year	9938
Other (specify):	9896
Total E: add Total C, Total D and Total E		$

Summary of expenses

Total C
Total D	+
Total E	+
Total expenses (enter on line 9968 on page 4)	$

Statement of farming activities (if applicable)

Other items

Other items	Code	Amount
Gross farming income (enter total from "Summary of income" on page 2)	9959
Minus: Total expenses (enter total from "Summary of expenses" on page 3)	9968
Net income (loss) before adjustments (line 9959 minus line 9968)	9969
Add: Optional inventory adjustments - current year (if applicable)	9941
Add: Mandatory inventory adjustments - current year (if applicable)	9942
Total (Optional inventory adjustments + Mandatory inventory adjustments)
Net income (loss) after adjustments	9944
Net farming income (loss)	9946

Shareholder/Member information

Name of shareholder/member	AgriStability and AgriInvest Participant Identification Number (PIN)

Partnership information

• Partnership Name:

Note: Enter a Participant Identification Number (PIN) for each of your partners. Enter the first and last names for individual partners. Enter the corporation's name for corporate partners. Your partnership's total shares must equal 100%.

• Your % share of the partnership:

Partnership Information

AgriStability and AgriInvest PIN	Individual's first name	Individual's last name	Corporation name	% share
				%
				%
				%
				%
				%
				%
				%

This page to be completed by AgriStability participants only

• PIN
• Has the productive capacity of this operation decreased during the program year due to disaster circumstances?
  • For crops: (Yes/No)
  • For livestock: (Yes/No)
• If you participated in crop or production insurance in the program year for this operation, please provide the Contract or Identification numbers in the following fields.

Crop inventory valuation and productive capacity

Code	Crop/Grade	Units	Acres	Unseedable acres	Quantity produced	Ending inventory	End of year price $
17	Summerfallow acres
18	Pasture acres
19	Wasteland acres

Livestock inventory valuation

Code	Description	Ending inventory	End of year price $

Livestock productive capacity

Productive animals

Productive animals		Units	2021
104	Cattle	Number of cows that calved
123	Hogs, farrow to finish	Number of sows that farrowed
145	Hogs, farrowing	Number of sows that farrowed

Number of feeder livestock

Number of feeder livestock		Units	2021
105	Feeder cattle (fed up to 900 lbs)	Number of animals fed
106	Finished cattle (fed over 900 lbs)	Number of animals fed
125	Hogs, nursery (fed up to 50 lbs)	Number of animals fed
124	Hogs, feeders (fed over 50 lbs)	Number of animals fed

Custom fed livestock

Custom fed livestock		Units	2021
141	Custom fed cattle	Number of animal feed days
142	Custom fed hogs	Number of animal feed days

Supply managed commodities

Supply managed commodities		Units	2021
113	Milk quota, milkfat	Number of kilograms butterfat/day
108	Chickens, layers, broiler eggs for hatching	Number of producing hens
109	Chickens, layers, eggs for consumption	Number of producing hens
143	Chickens, broilers	Number of kilograms produced
144	Turkeys, broilers	Number of kilograms produced

Other (specify below)

Other (specify below)		Units	2021

Purchased inputs

Code	Description	End of year amount ($)

Deferred income and receivables

Code	Description	Ending receivables and income deferred to 2022 ($)
4020	Expected grains and oilseeds pool payments

Accounts payable

Code	Description	End of year amount ($)

Confidential information and participant consent

Agriculture and Agri-Food Canada (AAFC) and the Canada Revenue Agency (CRA) are committed to protecting the privacy of your information. The information on this Statement A (hereafter this form), which includes Statement B where you have other farming operations, is collected under the authority of the Farm Income Protection Act and will be used exclusively for the purposes of:

• administering your participation in the AgriStability and AgriInvest programs
• determining your eligibility for benefits
• verifying the information submitted
• issuing tax receipts
• administering benefits under other farm income and special assistance programs
• audit, analysis, and evaluation of the AgriStability and AgriInvest programs and other farm income and special assistance programs by the Administration, AAFC, the provincial or territorial governments or third parties engaged for that purpose

The social insurance number (SIN) is collected under the authority of section 19 of the Farm Income Protection Act for the purposes of reporting a taxable benefit to the CRA.

By completing this form you authorize the Administration, the provincial and territorial governments, administrators of other farm income and special assistance programs, and third parties possessing information relevant to the administration of, and your participation in, the AgriStability and AgriInvest programs to share such information with AAFC.

All applicants except Status Indians and Band farms: by completing this form, you authorize the CRA to share information from this form with AAFC, and you authorize AAFC, where relevant, to share the information on the form and any additional information that is provided as the application is processed, with the CRA, the Administration, provincial and territorial governments and with the administrators of other federal/provincial farm programs.

Status Indians and Band farms: AAFC agrees that information provided by Status Indians and Band farms to the AgriStability and AgriInvest programs will not be disclosed to CRA by the Administration, unless disclosure is required by law. By completing and submitting this form you authorize the Administration to share information from this form with AAFC, and authorize AAFC to share the information on the form and any additional information that is provided as the application is processed, with provincial or territorial governments and with the administrators of other federal/provincial farm programs.

If you do not consent to the sharing of information described herein you may be ineligible to participate in the AgriStability or AgriInvest programs or receive benefits or adjustments to benefits under the AgriStability and AgriInvest programs.

You have the right to access the personal information held by federal departments and to request changes to incorrect personal information. For more information about your rights regarding the Privacy Act contact the Access to Information and Privacy Directorate at the Canada Revenue Agency at ATIP-AIPRP@cra-arc.gc.ca or the AAFC Access to Information and Privacy Coordinator at aafc.atip-aiprp.aac@agr.gc.ca and reference CRA PPU 005, CRA PPU 025 and/or AAFC PPU 183.

In addition, by submitting this form for benefits under the AgriStability and AgriInvest programs, you:

1. certify that the information provided is complete and correct
2. declare that the structure of this farming operation has not been altered or created for the purpose of manipulating program benefits or avoiding prescribed maximum limits on program payments
3. understand and agree that any interim or targeted advance payment of AgriStability program funds will be deducted in the calculation of a final AgriStability program payment
4. agree that you will repay any amounts paid to you by the AgriStability and AgriInvest programs that are in excess of the amount calculated under the program rules and understand that any amount you owe to the Crown may be subtracted from any payments to be sent to you by the Crown
5. understand that interest will be charged on overpayments
6. understand and agree that the information you submit may be combined with the information of other participants for the purposes of determining AgriStability and AgriInvest benefits, and consent to the disclosure of information pertaining to you or your financial affairs to the other participants who are being combined with your information
7. understand and certify that where you have provided information about other individuals or entities you have been authorized by those individuals or entities to provide that information
8. understand and agree that where you have provided information about other individuals or entities, if they request to see the information you have submitted about them, the Administration will give them access to that information
9. understand and agree that the person you identified on this form as your contact person may receive information relating to your application from the Administration and may instruct the Administration to modify information relating to your application
10. consent to third parties, CRA and other government programs disclosing to the Administration, upon its request, any information pertaining to you or your financial affairs which the Administration considers necessary for the purpose of verifying the AgriStability and AgriInvest benefit or the information provided on this form
11. understand that it is a criminal offence to make a false statement in application for program benefits and any declarations made are subject to audit