Form 13.1 - Financial Statement (Property And Support Claims) Page 4
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12Form 13.1:
Financial Statement (Property and
(page 4)
Court File Number:
Support Claims)
Complete this part only if you are making or responding to a claim for undue hardship or spousal support. Check and complete all
sections that apply to your circumstances.
1.
I live alone.
2.
I am living with
(full legal name of person you are married to or cohabiting with)
3.
I/we live with the following other adult(s):
4.
I/we have
of child(ren) who live(s) in the home.
(give number)
5.
My spouse/partner
works at
(place of work or business)
does not work outside the home.
6.
My spouse/partner
earns
$
per
.
(give amount)
does not earn any income.
7.
My spouse/partner or other adult residing in the home contributes about $
per
towards the household expenses.
PART 4: ASSETS IN AND OUT OF ONTARIO
If any sections of Parts 4 to 9 do not apply, do not leave blank, print “NONE” in the section.
The date of marriage is:
(give date)
The valuation date is:
(give date)
The date of commencement of cohabitation is (if different from date of marriage):
(give date)
PART 4(a): LAND
Include any interest in land owned on the dates in each of the columns below, including leasehold interests and mortgages. Show
estimated market value of your interest, but do not deduct encumbrances or costs of disposition; these encumbrances and costs
should be shown under Part 5 “Debts and Other Liabilities”.
Nature & Type of
Estimated Market value of YOUR interest
Ownership
Address of Property
on date of
on valuation
today
(Give your percentage
marriage
date
interest where relevant.)
Matrimonial Home
$0.00
$0.00
$0.00
15. TOTAL VALUE OF LAND
PART 4(b): GENERAL HOUSEHOLD ITEMS AND VEHICLES
Show estimated market value, not the cost of replacement for these items owned on the dates in each of the columns below. Do not
deduct encumbrances or costs of disposition; these encumbrances and costs should be shown under Part 5, “Debts and Other
Liabilities”.
Indicate if
Estimated Market value of YOUR interest
NOT in
Description
Item
on date of
on valuation
your
today
marriage
date
possession
Household goods
& furniture
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