Lance Carey Talbot: Barrister and Solicitor

FORM 13.1 Applicant(s)
Full legal name & address for service — street & number, municipality, postal code, telephone & fax numbers and email address (if any).		Lawyer's name & address — street & number, municipality, postal code, telephone & fax numbers and email address (if any).

Respondent(s)
Full legal name & address for service — street & number, municipality, postal code, telephone & fax numbers and email address (if any).		Lawyer's name & address — street & number, municipality, postal code, telephone & fax numbers and email address (if any).

INSTRUCTIONS

1. USE THIS FORM IF:

· you are making or responding to a claim for property or exclusive possession of the matrimonial home and its contents; or

· you are making or responding to a claim for property or exclusive possession of the matrimonial home and its contents together with other claims for relief.

2. DO NOT USE THIS FORM AND INSTEAD USE FORM 13 IF:

· you are making or responding to a claim for support but NOT making or responding to a claim for property or exclusive possession of the matrimonial home and its contents.


1.	My name is (full legal name)

	I live in (municipality & province)

and I swear/affirm that the following is true:

My financial statement set out on the following page is accurate to best of my knowledge and
belief and sets out the financial situation as of (date for which information is accurate)
[Month, Day, Year]

for:

**Check one or more boxes, as circumstances require.

me

the following person(s): (Give name(s) and relationship to you.)

NOTE:When you show monthly income and expenses, give the current actual amount if you know it or can find out. To get a monthly figure you must multiply any weekly income by 4.33 or divide any yearly income by 12.

PART 1: INCOME

for the 12 months from (date)	to (date)	. Include all income and other money that you get from all sources, whether taxable or not. Show the gross amount here and show your deductions in Part 3.

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	CATEGORY	MONTHLY
1.	Pay, wages, salary, including overtime (before deductions)
2.	Bonuses, fees, commissions
3.	Social assistance
4.	Employment insurance
5.	Workers' compensation
6.	Pensions
7.	Dividends
8.	Interest
9.	Rent, board received
10.	Canada Child Tax Benefit
11.	Support payments actually received
12.	Income received by children
13.	G.S.T. refund
14.	Payments from trust funds
15.	Gifts received
16.	Other (Specify.)

17.	INCOME FROM ALL SOURCES (TOTAL $)	*we calculate these totals for you

PART 2: OTHER BENEFITS Show your non-cash benefits – such as the use of company car, a club membership or room and board that your employer or someone else provides for you or benefits that are charged through or written off by your business.

ITEMS	DETAILS	MONTHLY MARKET Value

	TOTAL ($)	*we calculate this for you

19.

GROSS MONTHLY INCOME AND BENEFITS (ADD [17] plus [18]

TOTAL $

*we calculate this for you

PART 3: AUTOMATIC DEDUCTIONS FROM INCOME

for the 12 months from (date)

to (date)

TYPE OF EXPENSE		Monthly
20.	Income tax deducted from pay
21.	Canada Pension Plan
22.	Other pension plans
23.	Employment insurance
24.	Union or association dues
25.	Group insurance – Term Life
26.	Other (Specify.)

27.	TOTAL AUTOMATIC DEDUCTIONS ($)	*we calculate this for you

PART 7(e): BUSINESS INTERESTSShow any interest in an unincorporated business owned on the dates in each of the columns below. An interest in an incorporated business may be shown here or under “BANK ACCOUNTS, SAVINGS, SECURITIES AND PENSIONS” in Part 7(c). Give your best estimate of market value of your interest.

Name of Firm or Company

Interest

Estimated Market Value of YOUR interest
on date of marriage
on valuation date
today
84. TOTAL VALUE OF LAND

PART 7(f): MONEY OWED TO YOU
Give details of all money that other persons owe to you on the dates in each of the columns below, whether because of business or from personal dealings. Include any court judgments in your favour and any estate money and any income tax refunds owed to you.

Details

Estimated Market Value of YOUR interest
on date of marriage
on valuation date
today
84. TOTAL VALUE OF LAND

PART 7(g): OTHER PROPERTY
Show other property or assets owned on the dates in each of the columns below. Include property of any kind not listed above. Give your best estimate of market value.

Category

Details

Estimated Market Value of YOUR interest
on date of marriage
on valuation date
today
84. TOTAL VALUE OF LAND

PART 8: DEBTS AND OTHER LIABILITIES
Show your debts and other liabilities on the dates in each of the columns below. List them by category such as mortgages, charges, liens, notes, credit cards, and accounts payable. Don’t forget to include:
· any money owed to the Canada Customs and Revenue Agency;
· contingent liabilities such as guarantees or warranties given by you (but indicate that they are contingent); and
· any unpaid legal or professional bills as result of this case.

Category

Details

Estimated Market Value of YOUR interest
on date of marriage
on valuation date
today
84. TOTAL VALUE OF LAND

PART 9: PROPERTY, DEBTS AND OTHER LIABILITIES ON DATE OF MARRIAGE

Show by category the value of your property and your debts and other liabilities as of the date of your marriage. DO NOT INCLUDE THE VALUE OF A MATRIMONIAL HOME THAT YOU OWNED ON THE DATE OF MARRIAGE IF THIS PROPERTY IS STILL A MATRIMONIAL HOME ON THE VALUATION DATE.

Category and Details

Value on date of marriage
Assets	Liabilities

Land (exclude matrimonial home owned on date of marriage, unless sold before date of separation.)

General household items & vehicles

Bank accounts, savings, securities, pension

Life & disability insurance

Business interests

Money owed to you

Other property (Specify.)

Debts and other liabilities (Specify.)

PART 10: EXCLUDED PROPERTY
Show by category the value of property owned on the valuation date that is excluded from the definition of “net family property” (such as gifts or inheritances received after marriage).

Category				Details	Value on valuation date
Gift or inheritance from third person
Income from property expressly excluded by donor/testator
Damages and settlements for personal injuries, etc.
Life insurance proceeds
Traced property
Excluded property by spousal agreement
Other Excluded Property

PART 11: DISPOSED-OF PROPERTY
Show by category the value of all property that you disposed of during the two years immediately preceding the making of this statement, or during the marriage, whichever period is shorter.

Category	Details	Value

PART 12: CALCULATION OF NET FAMILY PROPERTY

Category	Deductions	Balance

text

	I do not expect any financial changes to my institution
x	I do expect changes in my financial situation as follows: The Respondent has been advised by his family physician, Dr. Corpus, that he should reduce the number of hours he is working due to stress. Consequently, his gross income may drop from the estimate of $105,000 per year to $86,000 per year.

	I attach a proposed budget in the format of Part 4 of this form.

Note:

NOTE: As soon as you find out that the information in this financial statement is incorrect or incomplete, or there is a material change in your circumstances that affects or will affect the information in this financial statement, you MUST serve on every other party to this case and file with the court:
· a new financial statement with updated information, or
· if changes are minor, an affidavit in Form 14A setting out the details of these changes.

Sworn/affirmed before me at:

Rolland Tourigny(This form to be signed in front of a lawyer,justice of the peace, notary public or commissioner for taking affidavits.)

City of Toronto

(Municipality)

in--- Province of Ontario

(Province, state or country)

on---

(date)

Lance Carey TalbotCommissioner for taking affidavits(Type or print below if signature is illegible.)

FINANCIAL STATEMENT
SUMMARY PAGE

BUDGET

Income
Income From All Sources
Other Benefits
Automatic Deductions From Income
Net Monthly Income

Expenses

NET FAMILY PROPERTY

Assets

Deductions

Exclusions

Notes:

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