Form 6-1-2 (Ag) - Income & Expense Form - Family Maintenance Enforcement Program printable pdf download

Form 6-1-2 (Ag) - Income & Expense Form - Family Maintenance Enforcement Program

FAMILY MAINTENANCE ENFORCEMENT PROGRAM

INCOME & EXPENSE FORM

PART 1: PERSONAL INFORMATION

FMEP Case #:

SIN:

Birthdate:

DD/MON/YR:

Name:

Home

Phone #:

Mailing Address:

Cell

Phone #:

Employer:

Work

Phone #:

Employer’s Address:

Employer’s

Phone #:

Number of people in your residence (including yourself):

Adults ________ Children (under age 19) ________

PART 2: ASSETS

Asset

Value

Details/Description

Chequing Account

$ _______________

Bank _________________________________________

Savings Account

$ _______________

Bank _________________________________________

RRSP/Investments/

Pensions/Savings Bonds

$ _______________

Financial Institution ______________________________

Real Estate

$ _______________

Address ______________________________________

(house, land, recreational property)

$ _______________

Address ______________________________________

Motor Vehicle(s)

$ _______________

Make/Model/Year_______________________________

$ _______________

Make/Model/Year_______________________________

Other Vehicle(s)

$ _______________

Make/Model/Year _______________________________

(motorcycles, trailers, motorhomes)

$ _______________

Make/Model/Year _______________________________

Household Items

$ _______________

(furniture, appliances, electronics)

Life Insurance Policy

$ _______________

(cash surrender value)

Other Asset(s)

$ _______________

Description ____________________________________

PART 3: DEBTS

Name of Creditor/Grantor

Type of Debt

Balance Owing

Monthly Payment

(e.g. bank, financial institution or finance co.)

(e.g. mortgage, loan, credit card)

_____________________________

_______________________

$ _____________

$ ______________

_____________________________

_______________________

$ _____________

$ ______________

_____________________________

_______________________

$ _____________

$ ______________

_____________________________

_______________________

$ _____________

$ ______________

TOTALS

$ _____________

$ ______________

The information on this form is collected pursuant to the Family Maintenance Enforcement Act for the purpose of monitoring and enforcing

your maintenance order or agreement. To obtain information about privacy protection, contact the FMEP office handling your case.

6-1-2 (AG)

Aug 2007

Form 6-1-2 (Ag) - Income & Expense Form - Family Maintenance Enforcement Program

Related Articles

Related forms

Related Categories