Financial Statement Page 4
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10Form 13.1: Financial Statement (Property and
(page 4)
Court File Number
Support Claims)
Utilities, continued
Personal, continued
Telephone
$
Education
$
(specify)
Entertainment/recreation (including
Cell phone
$
$
children)
Cable
$
Gifts
$
Internet
$
SUBTOTAL
$
SUBTOTAL
$
Other expenses
Household Expenses
Life Insurance premiums
$
Groceries
$
RRSP/RESP withdrawals
$
Household supplies
$
Vacations
$
Meals outside the home
$
School fees and supplies
$
Pet care
$
Clothing for children
$
Laundry and Dry Cleaning
$
Children’s activities
$
SUBTOTAL
$
Summer camp expenses
$
Childcare Costs
Debt payments
$
Daycare expense
$
Support paid for other children
$
Other expenses not shown above
(specify)
Babysitting costs
$
$
SUBTOTAL
$
SUBTOTAL
$
Total Amount of Monthly Expenses
$
Total Amount of Yearly Expenses
$
PART 3: OTHER INCOME EARNERS IN THE HOME
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):
I/we have
4.
(give number)
child(ren) who live(s) in the home.
works at
5. My spouse/partner
(place of work or business)
.
does not work outside the home.
earns
$
6. My spouse/partner
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.
Page 4 of 10
FLR-13.1-E (2015/01)
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