Financial Statement (Property And Support Claims) Page 3
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9Form 13.1:
Financial
Statement
(Property
and
(page 3)
Court File Number
Support Claims)
PART 4: TOTAL EXPENSES
for the 12 months from
to
(date)
(date)
NOTE: This part must be completed in all cases. You must set out your TOTAL living expenses, including those expenses involving
any children now living in your home. This part may also be used for a proposed budget. To prepare a proposed budget, photocopy
Part 4, complete as necessary, change the title to “Proposed Budget” and attach it to this form.
TYPE OF EXPENSE
Monthly
TYPE OF EXPENSE
Monthly
Housing
Child(ren)
29.
57.
Rent/mortgage
School activities (field trips, etc.)
30.
58.
Property taxes & municipal levies
School lunches
31.
Condominium fees & common
59.
School fees, books, tuition, etc. (for
expenses
children)
32.
Water
60.
Summer camp
33.
Electricity & heating fuel
61.
Activities (music lessons, clubs, sports)
34.
62.
Telephone
Allowances
35.
63.
Cable television & pay television
Baby sitting
36.
Home insurance
64.
Day care
37.
Home repairs, maintenance,
65.
Regular dental care
gardening
66.
Orthodontics or special dental care
67.
Sub-total of items [29] to [37]
Medicine & drugs
Food, Clothing and Transportation etc.
68.
Eye glasses or contact lenses
Sub-total of items [57] to [68]
38.
Groceries
Miscellaneous and Other
39.
Meals outside home
40.
General household supplies
69.
Books for home use, newspapers,
41.
Hairdresser, barber & toiletries
magazines, videos, compact discs
42.
Laundry & dry cleaning
70.
Gifts
43.
71.
Clothing
Charities
44.
72.
Public transit
Alcohol & tobacco
45.
Taxis
73.
Pet expenses
46.
Car insurance
74.
School fees, books, tuition, etc.
47.
Licence
75.
Entertainment & recreation
48.
76.
Car loan payments
Vacation
49.
77.
Credit cards (but not for expenses
Car maintenance and repairs
mentioned elsewhere in the statement)
50.
Gasoline & oil
51.
Parking
78.
R.R.S.P. or other savings plans
Sub-total of items [38] to [51]
79.
Support actually being paid in any other
(do not include child(ren)’s expenses)
Health and Medical
Case
52.
80.
Regular dental care
Income tax and Canada Pension Plan
(not deducted from pay)
53.
Orthodontics or special dental care
54.
Medicine & drugs
81.
Other (Specify. If necessary attach an extra
55.
Eye glasses or contact lenses
sheet.)
56.
Sub-total of items [69] to [81]
Life or term insurance premiums
Sub-total of items [52] to [56]
82.
Total of items [29] to [81]
SUMMARY OF INCOME AND EXPENSES
Net monthly income
=$
(item [28] above)
Subtract actual monthly expenses
=$
(item [82] above)
ACTUAL MONTHLY SURPLUS/DEFICIT
=$
FLR 13.1 (Rev. 04/03)
Page 3 of 9
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