5012-D (Page 1 of 3) 2025 Worksheet NT428 Use this worksheet to calculate the amounts to enter on your Form NT428, Northwest Territories Tax. Keep this worksheet for your records. Do not attach it to your return. Line 58080 - Age amount(if you were born in 1960 or earlier) If the amount from line 23600 of your return is: - $45,522 or less, enter $8,727 on line 58080 of your Form NT428 - $103,702 or more, enter "0" on line 58080 of your Form NT428 Otherwise, complete the calculation below. Line 1: Maximum amount 8,727.00 Line 2: Amount from line 23600 of your return ^ Line 3: Income threshold 45,522.00 Line 4: Line 2 minus line 3 (if negative, enter "0") = ^ Line 5: Applicable rate 15% Line 6: Line 4 multiplied by the percentage from line 5 = ^ Line 7: Line 1 minus line 6 (if negative, enter "0") Enter this amount on line 58080 of your Form NT428. = ^ Line 58200 - Amount for infirm dependants age 18 or older Complete one column for each dependant. If you have more than three dependants, use a separate sheet of paper. *** Transcriber's Note: In print, the following table is set-up as three columns. Column 1: Dependant 1; Column 2: Dependant 2; Column 3: Dependant 3. *** Line 1: Base amount Dependant 1: 14,305.00 Dependant 2: 14,305.00 Dependant 3: 14,305.00 Line 2: Dependant's net income from line 23600 of their return Dependant 1: ^ Dependant 2: ^ Dependant 3: ^ Line 3: Line 1 minus line 2 (if negative, enter "0") (maximum $5,914 per dependant) Dependant 1: = ^ Dependant 2: = ^ Dependant 3: = ^ Line 4: Amount claimed for this dependant on line 58160 of your Form NT428, if any Dependant 1: ^ Dependant 2: ^ Dependant 3: ^ Line 5: Allowable amount for this dependant: line 3 minus line 4 (if negative, enter "0") Dependant 1: = ^ Dependant 2: = ^ Dependant 3: = ^ Line 6: Add the amounts from line 5 of columns 1, 2, and 3 (and others, if any). Enter this amount on line 58200 of your Form NT428. ^ Line 58400 - Caregiver amount Complete one column for each dependant. If you have more than three dependants, use a separate sheet of paper. *** Transcriber's Note: In print, the following table is set-up as three columns. Column 1: Dependant 1; Column 2: Dependant 2; Column 3: Dependant 3. *** Line 1: Base amount Dependant 1: 26,111.00 Dependant 2: 26,111.00 Dependant 3: 26,111.00 Line 2: Dependant's net income from line 23600 of their return Dependant 1: ^ Dependant 2: ^ Dependant 3: ^ Line 3: Line 1 minus line 2 (if negative, enter "0") (maximum $5,914 per dependant) Dependant 1: = ^ Dependant 2: = ^ Dependant 3: = ^ Line 4: Amount claimed for this dependant on line 58160 of your Form NT428, if any Dependant 1: ^ Dependant 2: ^ Dependant 3: ^ Line 5: Allowable amount for this dependant: line 3 minus line 4 (if negative, enter "0") Dependant 1: = ^ Dependant 2: = ^ Dependant 3: = ^ Line 6: Add the amounts from line 5 of columns 1, 2, and 3 (and others, if any). Enter this amount on line 58400 of your Form NT428. ^ 5012-D (Page 2 of 3) Line 58440 - Disability amount for self Complete the following calculation if you were under 18 years of age on December 31, 2025: Line 1: Base amount 14,469.00 Line 2: Maximum amount 5,914.00 Line 3: Total child care and attendant care expenses for you, claimed by you or another person ^ Line 4: Threshold for child and attendant care expenses 3,464.00 Line 5: Line 3 minus line 4 (if negative, enter "0") = ^ Line 6: Line 2 minus line 5 (if negative, enter "0") = ^ Line 7: Line 1 plus line 6 Enter this amount on line 58440 of your Form NT428. (maximum $20,383) = ^ Line 58480 - Disability amount transferred from a dependant Complete this calculation for each dependant. If you have more than one dependant, use a separate sheet of paper. Note: If you and your dependant were not residents of the same province or territory at the end of the year, special rules may apply. For more information, call the Canada Revenue Agency at 1-866-426-1527. Line 1: Base amount 14,469.00 If the dependant was under 18 years of age on December 31, 2025, complete lines 2 to 12. If the dependant was 18 years of age or older, enter "0" on line 6 and continue on line 7. Line 2: Maximum amount 5,914.00 Line 3: Total child care and attendant care expenses for this dependant claimed by you or another person ^ Line 4: Threshold for child and attendant care expenses 3,464.00 Line 5: Line 3 minus line 4 (if negative, enter "0") = ^ Line 6: Line 2 minus line 5 (if negative, enter "0") = ^ Line 7: Line 1 plus line 6 (maximum $20,383) = ^ Line 8: Enter the amount from line 28 of the dependant's Form NT428. ^ Line 9: Line 7 plus line 8 = ^ Line 10: Dependant's taxable income from line 26000 of their return ^ Line 11: Line 9 minus line 10 (if negative, enter "0") = ^ Line 12: Enter whichever is less: amount from line 7 or line 11. Allowable amount for this dependant ^ Enter the total of allowable amounts claimed for all dependants on line 58480 of your Form NT428. Line 58729 - Allowable amount of medical expenses for other dependants Complete one column for each dependant. If you have more than three dependants, use a separate sheet of paper. *** Transcriber's Note: In print, the following table is set-up as three columns. Column 1: Dependant 1; Column 2: Dependant 2; Column 3: Dependant 3. *** Line 1: Medical expenses for other dependant Dependant 1: ^ Dependant 2: ^ Dependant 3: ^ Line 2: Enter the amount from line 41 of the dependant's Form NT428. Dependant 1: ^ Dependant 2: ^ Dependant 3: ^ Line 3: Line 1 minus line 2 (if negative, enter "0") (maximum $5,000 per dependant) Dependant 1: = ^ Dependant 2: = ^ Dependant 3: = ^ Line 4: Add the amounts from line 3 of columns 1, 2, and 3 (and others, if any). Enter this amount on line 58729 of your Form NT428. ^ 5012-D (Page 3 of 3) Line 61520 - Northwest Territories dividend tax credit Line A: Amount from line 12000 of your return ^ Line 1: Amount from line 12010 of your return Line B: ^ multiplied by 6% = ^ Line 2: Amount A minus amount B Line C ^ multiplied by 11.5% = ^ Line 3: Line 1 plus line 2 Enter this amount on line 61520 of your Form NT428. = ^ Line 65 - Northwest Territories political contribution tax credit Calculate the amount to enter on line 65 of your Form NT428 as follows: - For contributions of $100 or less, enter the amount of your contributions on line 65 - For contributions of $900 or more, enter $500 on line 65 Otherwise, complete the calculation below. Line 1: Enter your total political contributions from line 62550 of your Form NT428. ^ Line 2: 100.00 Line 3: Line 1 minus line 2 (cannot be negative) = ^ Line 4: 50% Line 5: Line 3 multiplied by the percentage from line 4 = ^ Line 6: 100.00 Line 7: Line 5 plus line 6 Enter this amount on line 65 of your Form NT428. (maximum $500) = ^