Newfoundland and Labrador Property Statement Form

In the Supreme Court of Newfoundland and Labrador Court File No.______
Trial Division (General/Family)
Central Divorce Registry No.______
Form 56A.27C (rule 56A.27)
Form 56A.27C
(rule 56A.27)
In the Supreme Court of Newfoundland and Labrador
Trial Division (General / Family)
Court No. _________________________________
Court File No. _____________________________
Central Divorce Registry No. _____________________________ (if applicable)
BETWEEN: ________________________________________________ APPLICANT
AND:
________________________________________________ RESPONDENT
Property Statement
I, (name) ____________________________________
(address) _________________________________ (city) ______________________________
(province) ____________________________ (postal code) _________ (phone) ________________
(fax) ___________________ swear (or affirm) that:
1. The information set out in this property statement is true and complete to the best of my
knowledge and belief and sets out all property held by me, in my name or jointly with another
person, as of (give date for which information is accurate) __________________
2. [ ] I do not anticipate any significant changes in the information set out in this property
statement.
or
[ ] I anticipate the following significant changes in the information set out in this
property statement:
SWORN TO OR AFFIRMED at _______________________________, in the Province
of Newfoundland and Labrador this ____ of _________________, 20 ___.
______________________________
Commissioner of Oaths/Justice of the Peace
______________________________
Signature
Rules of the Supreme Court, 1986
Page 1 of 6
Form Last Updated: Friday, September 10, 2010
In the Supreme Court of Newfoundland and Labrador Court File No.______
Trial Division (General/Family)
Central Divorce Registry No.______
Form 56A.27C (rule 56A.27)
I. Assets in and Out of Newfoundland and Labrador
I. PROPERTY OWNED
1. REAL PROPERTY
Include any interest in land owned on the date of application or as of the date of this
statement, including leasehold interests and mortgages. Show estimated market value of the
interest, but do not deduct encumrances or costs of disposition; these encumbrances and
costs should be shown under Part II, A Debts and Liabilities @ .
For example, if you were including the matrimonial home, you might insert both spouses
names in the first column and A Joint tenancy @ in the second column; in the next column,
you might write A Matrimonial home, 123 Main Street @ , in the fourth column, A $100,000",
which in the case o f such a joint tenancy would also b e the value to be placed in the final
column. The amount left to pay on the mortgage would be shown under Part II: A Debts and
Liabilities @ .
Owner
Nature &
Nature of Estimated
Estimated market
Type
property,
Total
value of the interest
of
and
Value
On date of
current
Ownership
address
separation
date
1. Total Value of Real Property
$
2. GENERAL HOUSEHOLD GOODS AND VEHICLES
Show estimated market value, not the cost of replacement for these items. Do not deduct
encumbrances, debts, loans or costs of disposition; these encumbrances and costs should be
shown under Part II, A Debts and Liabilities @ .
Item
Description
In the
Estimated market value
possession of
On date of
current date
separation
Household
goods,
appliances &
furniture
Cars, boats,
(describe by make,
trailers,
model, year)
motorhomes,
snowmobiles,
other vehicles
Jewellery
Rules of the Supreme Court, 1986
Page 2 of 6
Form Last Updated: Friday, September 10, 2010
Form 56A.27C (rule 56A.27)
In the Supreme Court of Newfoundland and Labrador Court File No.______
Trial Division (General/Family)
Central Divorce Registry No.______
Works of art,
collections,
electronics,
tools, sports
& hobby
equipment
Other special
items
2. Total Value of General Household Goods and
Vehicles
$
3. BANK ACCOUNTS AND SAVINGS
Show the items owned on the date of application by category. Include cash, savings and
chequing accounts in financial institutions, term deposits, guaranteed inve stment certificates,
and any other savings.
Owner
Category
Institution
Account
Amount
Number
On date of
current date
separation
3. Total Value of Bank Accounts and Savings
$
[ ] The location of any safety deposit box[es] is [name and address of institution(s)]:
______________________________________________________________________________
4. EMPLOYMENT BENEFITS (including Severance Pay, Retirement Allowances, Pensions
and Retirement Savings Plans, Profit Sharing Plans, Accrued Annual Leave, etc. )
Show the items owned by category. Indicate the name and address of the institution and other
relevant details of the benefit(s).
Owner
Category
Institution
Account
Amount
Number
on date of
current date
separation
4. Total Value of Employment Benefits
Rules of the Supreme Court, 1986
$
Page 3 of 6
Form Last Updated: Friday, September 10, 2010
Form 56A.27C (rule 56A.27)
In the Supreme Court of Newfoundland and Labrador Court File No.______
Trial Division (General/Family)
Central Divorce Registry No.______
5. SECURITIES
Show the items owned by category. Include shares, bonds, m utual funds, warrants, options,
debentures, notes and any other securities. Give your best estimate of their market value if
the items were to be sold on the open market.
Owner
Category
Number
Description
Estimated Market Value
on date of
current date
separation
5. Total Value of Securities
$
6. LIFE & DISABILITY INSURANCE
List all whole life, term life, disability or other similar insurance policies. Set out cash
surrender value, if any.
Company
Kind of
Owner
Beneficiary
Face
Cash Surrender
& Policy
Policy
Amount
Value
No.
on date of current
separation
date
6. Total Cash Surrender Value of Insurance Policies
$
7. BUSINESS INTERESTS
If there is a claim for division of business assets , list any interest either spouse holds, directly
or indirectly, in any incorporated business, including partnerships, trusts and joint ventures.
Give your best estimate of market value if business were to be sold on an open market. An
interest in an incorporated business may be shown here or under item 5: Securities.
Interest Held By
Name of Firm or
Interest
Estimated Market Value of the
Company
Interest
on date of
current date
separation
7. Total Value of Business Interests
Rules of the Supreme Court, 1986
$
Page 4 of 6
Form Last Updated: Friday, September 10, 2010
Form 56A.27C (rule 56A.27)
In the Supreme Court of Newfoundland and Labrador Court File No.______
Trial Division (General/Family)
Central Divorce Registry No.______
8. ACCOUNTS RECEIVABLE
Give details of all money owed to either spouse, whether because of business or from
personal dealings; including amounts loaned to family members, any court judgments in a
spouse's favour, any estate money owed.
Owed To
Details
Amount Owed
on date of
current date
separation
8. Total of Accounts Receivable
$
9: OTHER PROPERTY
Show other property or assets owned by categories. Include property of any kind not listed in
items 1 to 8 (for example, patents or copyright claims). Give your best estimate of market
value.
Owner
Category
Details
Estimated Market Value of the
Interest
on date of
current date
separation
9. Total Value of Other Property
$
I. VALUE OF ALL ASSETS (Add totals 1 to 9 together) I. + $__________
Rules of the Supreme Court, 1986
Page 5 of 6
Form Last Updated: Friday, September 10, 2010
In the Supreme Court of Newfoundland and Labrador Court File No.______
Trial Division (General/Family)
Central Divorce Registry No.______
Form 56A.27C (rule 56A.27)
II. DEBTS AND OTHER LIABILITIES
Show all debts and other liabilities. Include business debts if a claim is being made for division
of business assets. List by category, such as mortgages, charges, loans, liens, notes, credit
cards, accounts payable, tax arrears and costs of disposition. Indicate if any other person may
be responsible for this debt with a spouse and give their name. Include contingent liabilities
such as guarantees given by either spouse and indicate th at they are contingent . Indicate if any
debt payments are in arrears.
Debtor
Category
Details
(interest rate, term or
number of payments
remaining, any property
affected)
II. Total of Debts and Other Liabilities
Amount Owing
on date of
current date
separation
$
III. PROPERTY EXEMPT FROM DISTRIBUTION
Show the value by category of property reported in this statement that you claim is exempt from
distribution pursuant to section 18(c) of the Family Law Act.
Category
Item And Reasons For Exemption
IV. Total Value of Exempt Property
Value on date of
application
$
IMPORTANT NOTE: If during the course of the proceeding you find out that the information in
this property statement is incorrect or incomplete or there is a material change in the
information provided, you must serve on every other party to this claim and file with the court
the correct information or a new property statement containing the correct information, together
with any documents that back up that information.
Rules of the Supreme Court, 1986
Page 6 of 6
Form Last Updated: Friday, September 10, 2010