Statement of eligible remuneration headspace

Page 1

IN THE MATTER OF:

Digital Media Tax Credit Regulations made under Section 47A of the Income Tax Act, R.S.N.S. 1989, c. 217, s. 3(h) -andAd-Dispatch.Com Inc. APPLICANT CORPORATION STATEMENT OF ELIGIBLE REMUNERATION1

I,

Kyle Racki

, of

Headspace Design

SUPPLIER

,

CORPORATION

of the Province of Nova Scotia, make oath and say as follows:

I have supplied the Applicant Corporation identified above with goods and/or services for the product titled

Eastlink Training - Ergonomics

, in

the amount of $

22,250.00

invoice(s) dated

October 15, 2009 – July 8, 2010. My primary North American Industrial

(net of HST), as indicated on the attached

Classification (NAICS) Code is _________________. I attest that the percentage of salaries and 541511 wages paid to employees reporting to a permanent establishment in Nova Scotia represented in the invoice(s) amount is

100

%. This calculates to $

22,250.00 worth of

eligible remuneration. In addition, I will provide any requested information to the Nova Scotia Department of Finance for all employees whose labour is included in the calculation of eligible remuneration, for audit purposes, upon their request.

SWORN TO at in NOVA SCOTIA, this of

, 20

) , Province of ) day) , before me)

__________________________________ WITNESS 1

_______________________________ SUPPLIER

“Eligible Remuneration” ” is defined in Section 10 of the Digital Media Tax Credit Regulations.


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