Statutory Declaration To Sheriff

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ONTARIO
Court File Number
(Name of court)
Form 28B: Statutory
at
Declaration to Sheriff
Court office address
Recipient(s)
Full legal name & address for service — street & number, municipality,
Lawyer’s name & address — street & number, municipality, postal
postal code, telephone & fax numbers and e-mail address (if any).
code, telephone & fax numbers and e-mail address (if any).
Payor
Full legal name & address for service — street & number, municipality,
Lawyer’s name & address — street & number, municipality, postal
postal code, telephone & fax numbers and e-mail address (if any).
code, telephone & fax numbers and e-mail address (if any).
My name is
(full legal name)
I live in
(municipality & province)
and I declare that the following is true:
1. I am
a recipient under a payment order.
an assignee of a recipient under a payment order.
an agent of the Director of the Family Responsibility Office.
other
(Specify.)
2. On
a writ of seizure and sale was issued in this case,
(date)
a copy of which is attached.
3. Since then, the amount owed by the payor has changed and, as of today, the amount owed stands at
$
with interest on it at the rate of
% per year beginning
on
(date when interest begins)
4. The amount in paragraph 3 includes unpaid support of $
which, under
subsection 4(1) of the Creditors’ Relief Act, gets priority over other judgments and orders.
5. An additional Assignment of Judgment of Costs in the amount of
$
(write NIL if none)
has been made in favour of Legal Aid Ontario which, under subsections 46(4) and 47(1) of the Legal Aid Services
Act, 1998, must be deducted from the proceeds of the sale and paid to Legal Aid Ontario.
6. The amount in paragraph 3 includes $
as a fine for contempt of this court,
a forfeited bond or a forfeited recognizance arising out of a civil proceeding and made payable to,
Her Majesty the Queen
other
(Specify.)
and, under subsection 143(3) of the Courts of Justice Act, the writ of seizure and sale can be executed immediately
to collect that amount without a direction to enforce.
Declared before me at
municipality
in
province, state or country
Signature
on
(This form is to be signed in front of a
date
Commissioner for taking affidavits
lawyer, justice of the peace, notary public
(Type or print name below if signature is illegible.)
or commissioner for taking affidavits.)
FLR 28B (September 1, 2005)
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