5012-C (Page 1 of 3) Protected B when completed 2025 Form NT428 Northwest Territories Tax For more information about this form, go to canada.ca/nt-tax-info. Part A - Northwest Territories tax on taxable income Line 1: Enter your taxable income from line 26000 of your return. ^ Use the amount from line 1 to complete the appropriate column below. *** Transcriber's Note: Use column 1 if the amount on line 1 is $51,964 or less. Use column 2 if the amount on line 1 is more than $51,964, but not more than $103,930. Use column 3 if the amount on line 1 is more than $103,930 but not more than $168,967. Use column 4 if the amount on line 1 is more than $168,967. *** Column 1: Line 1 is $51,964 or less Line 2: Amount from line 1 ^ Line 3: 0.00 Line 4: Line 2 minus line 3 (cannot be negative) = ^ Line 5: Rate 5.9% Line 6: Line 4 multiplied by the percentage from line 5 = ^ Line 7: 0.00 Line 8: Line 6 plus line 7 Northwest Territories tax on taxable income = ^ Column 2: Line 1 is more than $51,964 but not more than $103,930 Line 2: Amount from line 1 ^ Line 3: 51,964.00 Line 4: Line 2 minus line 3 (cannot be negative) = ^ Line 5: Rate 8.6% Line 6: Line 4 multiplied by the percentage from line 5 = ^ Line 7: 3,065.88 Line 8: Line 6 plus line 7 Northwest Territories tax on taxable income = ^ Column 3: Line 1 is more than $103,930 but not more than $168,967 Line 2: Amount from line 1 ^ Line 3: 103,930.00 Line 4: Line 2 minus line 3 (cannot be negative) = ^ Line 5: Rate 12.2% Line 6: Line 4 multiplied by the percentage from line 5 = ^ Line 7: 7,534.95 Line 8: Line 6 plus line 7 Northwest Territories tax on taxable income = ^ Column 4: Line 1 is more than $168,967 Line 2: Amount from line 1 ^ Line 3: 168,967.00 Line 4: Line 2 minus line 3 (cannot be negative) = ^ Line 5: Rate 14.05% Line 6: Line 4 multiplied by the percentage from line 5 = ^ Line 7: 15,469.47 Line 8: Line 6 plus line 7 Northwest Territories tax on taxable income = ^ Enter the amount from line 8 on line 52 and continue at line 9. Part B - Northwest Territories non-refundable tax credits Line 56100: Internal use Line 9 and line 58040: Basic personal amount Claim $17,842 ^ Line 10 and line 58080: Age amount (if you were born in 1960 or earlier) (use Worksheet NT428) (maximum $8,727) ^ Spouse or common-law partner amount: Line 11: Base amount 17,842.00 Line 12: Your spouse's or common-law partner's net income from line 23600 of their return ^ Line 13 and line 58120: Line 11 minus line 12 (if negative, enter "0") = ^ Amount for an eligible dependant: Line 14: Base amount 17,842.00 Line 15: Your eligible dependant's net income from line 23600 of their return ^ Line 16 and line 58160: Line 14 minus line 15 (if negative, enter "0") = ^ Line 17 and line 58200: Amount for infirm dependants age 18 or older (use Worksheet NT428) ^ Line 18: Add lines 9, 10, 13, 16, and 17. = ^ CPP or QPP contributions: Line 19 and line 58240: Amount from line 30800 of your return ^ Line 20 and line 58280: Amount from line 31000 of your return ^ Employment insurance premiums: Line 21 and line 58300: Amount from line 31200 of your return ^ Line 22 and line 58305: Amount from line 31217 of your return ^ Line 23: Add lines 19 to 22. = ^ Line 24: Line 18 plus line 23 = ^ 5012-C (Page 2 of 3) Part B - Northwest Territories non-refundable tax credits (continued) Line 25: Amount from line 24 of the previous page ^ Line 26 and line 58360: Pension income amount (maximum $1,000) ^ Line 27 and line 58400: Caregiver amount (use Worksheet NT428) ^ Line 28: Add lines 25 to 27. = ^ Line 29 and line 58440: Disability amount for self (claim $14,469, or if you were under 18 years of age, use Worksheet NT428) ^ Line 30 and line 58480: Disability amount transferred from a dependant (use Worksheet NT428) ^ Line 31: Add lines 28 to 30. = ^ Line 32 and line 58520: Interest paid on your student loans (amount from line 31900 of your return) ^ Line 33 and line 58560: Your tuition and education amounts (attach Schedule NT(S11)) ^ Line 34 and line 58600: Tuition and education amounts transferred from a child or grandchild ^ Line 35 and line 58640: Amounts transferred from your spouse or common-law partner (attach Schedule NT(S2)) ^ Line 36: Add lines 31 to 35. = ^ Medical expenses: Line 37 and line 58689: Amount from line 33099 of your return ^ Line 38: Amount from line 23600 of your return ^ Line 39: Applicable rate 3% Line 40: Line 38 multiplied by the percentage from line 39 = ^ Line 41: Enter whichever is less: $2,834 or the amount on line 40. ^ Line 42: Line 37 minus line 41 (if negative, enter "0") = ^ Line 43 and line 58729: Allowable amount of medical expenses for other dependants (use Worksheet NT428) ^ Line 44 and line 58769: Line 42 plus line 43 = ^ Line 45 and line 58800: Line 36 plus line 44 = ^ Line 46: Northwest Territories non-refundable tax credit rate 5.9% Line 47 and line 58840: Line 45 multiplied by the percentage from line 46 = ^ Donations and gifts: Line 48: Amount from line 13 of your federal Schedule 9 ^ multiplied by 5.9% = ^ Line 49: Amount from line 14 of your federal Schedule 9 ^ multiplied by 14.05% = ^ Line 50 and line 58969: Line 48 plus line 49 = ^ Line 51 and line 61500: Line 47 plus line 50 Enter this amount on line 55. Northwest Territories non-refundable tax credits = ^ 5012-C (Page 3 of 3) Part C - Northwest Territories tax Line 52: Northwest Territories tax on taxable income from line 8 ^ Line 53 and line 61510: Northwest Territories tax on split income (complete Form T1206) ^ Line 54: Line 52 plus line 53 = ^ Line 55: Northwest Territories non-refundable tax credits from line 51 ^ Line 56 and line 61520: Northwest Territories dividend tax credit (use Worksheet NT428) ^ Northwest Territories minimum tax carryover: Line 57 and line 61540: Amount from line 40427 of your return ^ multiplied by 45% = ^ Line 58: Add lines 55 to 57. = ^ Line 59: Line 54 minus line 58 (if negative, enter "0") = ^ Northwest Territories additional tax for minimum tax purposes: Line 60: Amount from Line 14 of Part 7 of Form T691 ^ multiplied by 45% = ^ Line 61: Line 59 plus line 60 = ^ Line 62: Territorial foreign tax credit (complete Form T2036) ^ Line 63: Line 61 minus line 62 (if negative, enter "0") = ^ Line 64 and line 62550: Northwest Territories political contributions made in 2025 ^ Line 65: Northwest Territories political contribution tax credit (use Worksheet NT428) (maximum $500) ^ Line 66: Line 63 minus line 65 (if negative, enter "0") Enter this amount on line 42800 of your return. Northwest Territories tax = ^ See the privacy notice on your return.