ONTARIO

Court File Number

Superior Court of Justice, Family Court

(Name of court)

Form 13.1: Financial Statement (Property and Support Claims) sworn/affirmed

at

! C"urc" Street, St. Cat"arines, #ntario $%& '()

Court office address

*pplicant(s)
Full legal name & address for service street & number, munici alit!, ostal code, tele "one & fa# numbers and e$mail address (if an!)% &a'!er(s name & address street & number, munici alit!, ostal code, tele "one & fa# numbers and e$mail address (if an!)%

Frances +ar,orie -ouseman . / 0 $ois $ane, St. Cat"arines, #ntario $%1 /& , 2el:(!3 ).000.0000 Fa4: (!3 ).000.000' &espondent(s)
Full legal name & address for service street & number, munici alit!, ostal code, tele "one & fa# numbers and e$mail address (if an!)%

5a6id Screwem . 0 Fa7e Street, St. Cat"arines, #ntario $3+ 1&3, 2el: (!3 ) 0)).!%'1, Fa4: (!3 ) 0)).3300

&a'!er(s name & address street & number, munici alit!, ostal code, tele "one & fa# numbers and e$mail address (if an!)%

Jonat"an 8dward Castle . 5i6orce Court, Jordan, #ntario $3& 19) 2el:(!3 ). . Fa4:(!3 ). . 0

8li:a;et" Payne . 13 +ain Street <est, =rims;y, #ntario $3+ %S1, 2el:(!3 ) !/ .%%11 Fa4:(!3 ) !/ . %%3%

>(S2&?C2>#(S 1. USE THIS FORM IF: @ you are making or responding to a laim !or property or e" lusi#e possession o! t$e matrimonial $ome and its ontents% or @ you are making or responding to a laim !or property or e" lusi#e possession o! t$e matrimonial $ome and its ontents toget$er &it$ ot$er laims !or relie!' USE FORM () INSTE*+ OF THIS FORM IF: @ you are making or responding to a laim !or support but NOT making or responding to a laim !or property or e" lusi#e possession o! t$e matrimonial $ome and its ontents' I! you $a#e in ome t$at is not s$o&n in ,art I o! t$e !inan ial statement -!or e"ample. partners$ip in ome. di#idends. rental in ome. apital gains or RRS, in ome/. you must also omplete Sc"edule *' I! you or t$e ot$er party $as soug$t a ontribution to&ards spe ial or e"traordinary e"penses !or t$e $ild-ren/. you must also omplete Sc"edule 9'
licable sc"edules% Failure to do so ma! result

%.

3. /.

NOT)* +ou must fully and truthfully com lete t"is financial statement, including an! a in serious conse,uences%

1.

+y name is (full legal name) Frances +ar,orie -ouseman > li6e in (munici alit! & rovince) &eAional +unicipality of (iaAara, Pro6ince of #ntario and > swear/affirm t"at t"e followinA is true: P*&2 1: >(C#+8

%.

I am urrently employed by (name and address of em lo!er) 5r. 2oot" 5ental #ffice 1%3 2orture *6enue, St. Cat"arines, #ntario $0- '?% sel!0employed. arrying on business under t$e name o! (name and address of business) unemployed sin e (date '"en last em lo!ed)

F1R ()'( -February (. 23(3/

,age ( o! (3

Form 13.1:

Financial Statement (Property and Support Claims)

(paAe %)

Court !ile number

8rror: &eference source not found

licable):

3.

I atta $ proo! o! my year0to0date in ome !rom all sour es. in luding my most re ent (attac" all t"at are a pay $e4ue stub so ial assistan e stub pension stub employment insuran e stub and last Re ord o! Employment statement o! in ome and e"penses6 pro!essional a ti#ities -!or sel!0employed indi#iduals/ ot$er -e'g' a letter !rom your employer on!irming all in ome re ei#ed to date t$is year/

&orkers5 ompensation stub

/. .

1ast year. my gross in ome !rom all sour es &as 7

deducted from t"is income)%

3 !.%/ (do not subtract an! ta#es t"at "ave been

I am atta $ing all o! t$e !ollo&ing re4uired do uments to t$is !inan ial statement as proo! o! my in ome o#er t$e past t$ree years. i! t$ey $a#e not already been pro#ided: . a opy o! my personal in ome ta" returns !or ea $ o! t$e past t$ree ta"ation years. in luding any materials t$at &ere !iled &it$ t$e returns' (Income ta# returns must be served but s"ould NOT be filed in t"e continuing
record, unless t"e! are filed 'it" a motion to refrain a driver(s license sus ension%)

. .

a opy o! my noti es o! assessment and any noti es o! reassessment !or ea $ o! t$e past t$ree ta"ation years% &$ere my noti es o! assessment and reassessment are una#ailable !or any o! t$e past t$ree ta"ation years. an In ome and +edu tions printout !rom t$e Canada Re#enue *gen y !or ea $ o! t$ose years. &$et$er or not I !iled an in ome ta" return'
Note* An Income and -eductions rintout is available from Canada Revenue Agenc!% .lease call customer service at /$011$232$040/%

#& I am an Indian &it$in t$e meaning o! t$e Indian Act -Canada/ and I $a#e $osen not to !ile in ome ta" returns !or t$e past t$ree years' I am atta $ing t$e !ollo&ing proo! o! in ome !or t$e last t$ree years (list documents !ou "ave rovided):
(In t"is table !ou must s"o' all of t"e income t"at !ou are currentl! receiving%)

>ncome Source 1. %. 3. /. . 0. '. ). !. 13. 11. 1%. 13. Employment in ome -be!ore dedu tions/ Commissions. tips and bonuses Sel!0employment in ome -Mont$ly amount be!ore e"penses: 7 / Employment Insuran e bene!its 8orkers5 ompensation bene!its So ial assistan e in ome -in luding O+S, payments/ Interest and in#estment in ome ,ension in ome -in luding C,, and O*S/ Spousal support re ei#ed !rom a !ormer spouse6partner C$ild Ta" 9ene!its or Ta" Rebates -e'g' :ST/ Ot$er sour es o! in ome -e'g' RRS, &it$dra&als. apital gains/ (5attac" 6c"edule A
and divide annual amount b! /4)

*mount &ecei6ed/+ont" B B B B B B B B B B B B B /,/13.%' %33.33 /,013.%' ,3 !.%/

,age 2 o! (3

2otal mont"ly income from all sources: 2otal mont"ly income C 1% D 2otal annual income:

F1R ()'( -February (. 23(3/

Form 13.1:

Financial Statement (Property and Support Claims)

(paAe 3)

Court !ile number

8rror: &eference source not found

1/. #t"er 9enefits

.rovide details of an! non$ cas" benefits t"at !our em lo!er rovides to !ou or are aid for b! !our business suc" as medical insurance coverage, t"e use of a com an! car, or room and board%

>tem

5etails B B B B P*&2 %: 8CP8(S8S 84pense +ont"ly *mount 84pense 2ransportation B B B B B B

%3%.3) '0.1/ !)1. ' 1% !..'!

Eearly +ar7et Falue

+ont"ly *mount

*utomatic 5eductions C,, ontributions EI premiums In ome ta"es Employee pension ontributions Union dues S?92#2*$ -ousinA Rent or mortgage ,roperty ta"es ,roperty insuran e Condominium !ees Repairs and maintenan e S?92#2*$ ?tilities 8ater Heat Ele tri ity B B B
)3.33 !3.33 1%3.33

,ubli transit. ta"is :as and oil Car insuran e and li ense Repairs and maintenan e ,arking Car 1oan or 1ease ,ayments S?92#2*$

B B B B B B B

3 3.33 1 3.33 .33 .33

B B B B B B

1133.33 333.33 0%. 3 133 1 0%. 3

-ealt" Healt$ insuran e premiums +ental e"penses Medi ine and drugs Eye are S?92#2*$ Personal Clot$ing Hair are and beauty *l o$ol and toba o B B B
% .33 /3.33

B B B B B

01.0' 33.33 !1.0'

F1R ()'( -February (. 23(3/

,age ) o! (3

Form 13.1:

Financial Statement (Property and Support Claims)

(paAe /)

Court !ile number

8rror: &eference source not found Personal, continued

?tilities, continued Telep$one Cell p$one Cable Internet S?92#2*$ -ouse"old 84penses :ro eries House$old supplies Meals outside t$e $ome ,et are 1aundry and +ry Cleaning S?92#2*$ C"ildcare Costs +ay are e"pense 9abysitting osts S?92#2*$ B B B
)00.33 )00.33

B B B B B

3.33 0 .33 03.33 /0 .33

Edu ation -s ecif!/ Entertainment6re reation -in luding $ildren/ :i!ts S?92#2*$ #t"er e4penses 1i!e Insuran e premiums

B B B B

3.33 133.33 %1 .33

B B B B B B B B B B B B B

33.33 133.!% ' .33 %33.33 /1.0' 3.33 %3.33 %3. !

B B B B B B

3!).30 3.33 13).% %3.33 '0.01

RRS,6RES, &it$dra&als ;a ations S $ool !ees and supplies Clot$ing !or $ildren C$ildren<s a ti#ities Summer amp e"penses +ebt payments Support paid !or ot$er $ildren Ot$er e"penses not s$o&n abo#e (s ecif!) S?92#2*$

2otal *mount of +ont"ly 84penses 2otal *mount of Eearly 84penses P*&2 3: #2-8& >(C#+8 8*&(8&S >( 2-8 -#+8
Com lete t"is art onl! if !ou are ma7ing or res onding to a claim for undue "ards"i or s ousal su sections t"at a l! to !our circumstances%

011%.10 '33/ .!%

ort% C"ec7 and com lete all

1. %. 3. /.

I li#e alone' I am li#ing &it$ (full legal name of erson !ou are married to or co"abiting
'it")

'

I6&e li#e &it$ t$e !ollo&ing ot$er adult-s/: I6&e $a#e (give number) $ild-ren/ &$o li#e-s/ in t$e $ome' ' ' per
,age = o! (3

. My spouse6partner 0. '. My spouse6partner

&orks at ( lace of 'or7 or business) does not &ork outside t$e $ome' earns (give amount) 7 does not earn any in ome' per

My spouse6partner or ot$er adult residing in t$e $ome ontributes about 7 to&ards t$e $ouse$old e"penses'

F1R ()'( -February (. 23(3/

Form 13.1:

Financial Statement (Property and Support Claims)

(paAe )

Court !ile number

8rror: &eference source not found

P*&2 /: *SS82S >( *(5 #?2 #F #(2*&>#

If an! sections of .arts 8 to 2 do not a l!, do not leave blan7, rint 9NON): in t"e section%

T$e date o! marriage is: (give date) T$e #aluation date is: (give date)

%%/3)/%33/ 1//3!/%313

T$e date o! ommen ement o! o$abitation is -i! di!!erent !rom date o! marriage/: (give date) P*&2 /(a): $*(5

Include an! interest in land owned on t"e dates in eac" of t"e columns belo', including lease"old interests and mortgages% 6"o' estimated mar7et value of !our interest, but do not deduct encumbrances or costs of dis osition; t"ese encumbrances and costs s"ould be s"o'n under .art 3, 9-ebts and Ot"er &iabilities:%

(ature G 2ype of #wners"ip

(<ive !our ercentage interest '"ere relevant%)

8stimated +ar7et Falue of E#?& >nterest *ddress of Property / 0 $ois $ane St. Cat"arines, #ntario $%1 /& B on date of marriaAe on 6aluation date today

+atrimonial -ome, Joint 2enants

1/3333.33 B 1/3333.33

1 . 2#2*$ F*$?8 #F $*(5 B 1/3333.33 P*&2 /(;): =8(8&*$ -#?S8-#$5 >28+S *(5 F8->C$8S

B 1/3333.33

6"o' estimated mar7et value, not t"e cost of re lacement for t"ese items o'ned on t"e dates in eac" of t"e columns belo'% -o not deduct encumbrances or costs of dis osition; t"ese encumbrances and costs s"ould be s"o'n under .art 3, 9-ebts and Ot"er &iabilities:%

>tem
House$old goods > !urniture

5escription Furniture *nd -ouse"old =oods 3H of t"e B/333 %313 Pontiac Fi;e

>ndicate if (#2 in your possession

8stimated +ar7et Falue of E#?& >nterest on date of on 6aluation today marriaAe date B B %333.33 B %333.33

Cars. boats. #e$i les

10333.33 B

10333.33

?e&ellery. art. ele troni s. tools. sports > $obby e4uipment Ot$er spe ial items

10. 2#2*$ F*$?8 #F =8(8&*$ -#?S8-#$5 >28+S *(5 F8->C$8S B

F1R ()'( -February (. 23(3/

1)333.33

1)333.33
,age @ o! (3

Form 13.1:

Financial Statement (Property and Support Claims)

(paAe 0)

Court !ile number

8rror: &eference source not found

P*&2 /(c): 9*(1 *CC#?(2S, S*F>(=S, S8C?&>2>8S *(5 P8(S>#(S

6"o' t"e items o'ned on t"e dates in eac" of t"e columns belo' b! categor!, for e#am le, cas", accounts in financial institutions, ensions, registered retirement or ot"er savings lans, de osit recei ts, an! ot"er savings, bonds, 'arrants, o tions, notes and ot"er securities% <ive !our best estimate of t"e mar7et value of t"e securities if t"e items 'ere to be sold on t"e o en mar7et%

CateAory Sole 9an7 *ccount

>(S2>2?2>#( (including location)/ 58SC&>P2>#( (including issuer and date) 9an7 of +ontreal

*ccount num;er I! /%31 B

*mount/8stimated +ar7et Falue on date of marriaAe on 6aluation date 3.33 B today 3.33

1 33.33 B

1'. 2#2*$ F*$?8 #F *CC#?(2S, S*F>(=S, S8C?&>2>8S *(5 P8(S>#(S B P*&2 /(d): $>F8 *(5 5>S*9>$>2E >(S?&*(C8
&ist all olicies in e#istence on t"e dates in eac" of t"e columns belo'%

3.33 B

3.33

Company, 2ype G Policy (o. $ondon $ife, $ife 2erm, I/// 3//

#wner Frances +ar,orie -ouseman

9eneficiary $isa -ouseman, >n 2rust

Cas" Surrender Falue on date of on 6aluation today marriaAe date 133333.33 B B B Face *mount

1). 2#2*$ C*S- S?&&8(58& F*$?8 #F >(S?&*(C8 P#$>C>8S B P*&2 /(e): 9?S>(8SS >(28&8S2S

3.33 B

3.33

6"o' an! interest in an unincor orated business o'ned on t"e dates in eac" of t"e columns belo'% An interest in an incor orated business ma! be s"o'n "ere or under 9=AN> ACCO?NT6, 6A@IN<6, 6)C?RITI)6, AN- .)N6ION6: in .art 8(c)% <ive !our best estimate of t"e mar7et value of !our interest%

8stimated +ar7et Falue of E#?& >nterest (ame of Firm or Company >nterest B on date of marriaAe on 6aluation date B today

1!. 2#2*$ F*$?8 #F 9?S>(8SS >(28&8S2S B

F1R ()'( -February (. 23(3/

,age A o! (3

Form 13.1:

Financial Statement (Property and Support Claims)

(paAe ')

Court !ile number

8rror: &eference source not found

P*&2 /(f): +#(8E #<85 2# E#?

<ive details of all mone! t"at ot"er ersons o'e to !ou on t"e dates in eac" of t"e columns belo', '"et"er because of business or from ersonal dealings% Include an! court Audgments in !our favour, an! estate mone! and an! income ta# refunds o'ed to !ou%

*mount #wed to Eou 5etails B on date of marriaAe on 6aluation date B today

%3. 2#2*$ #F +#(8E #<85 2# E#? B P*&2 /(A): #2-8& P&#P8&2E

6"o' ot"er ro ert! or assets o'ned on t"e dates in eac" of t"e columns belo'% Include ro ert! of an! 7ind not listed above% <ive !our best estimate of mar7et value%

8stimated +ar7et Falue of E#?& interest CateAory >n"eritance 5etails &oyal 5alton Collection B on date of marriaAe on 6aluation date 1%333.33 B today 1%333.33

%1. 2#2*$ F*$?8 #F #2-8& P&#P8&2E B %%. F*$?8 #F *$$ P&#P8&2E #<(85 #( 2-8 F*$?*2>#( 5*28
(Add items J1 K to J%1K%) B

1%333.33 B 1'3333.33 B

1%333.33

P*&2 : 5892S *(5 #2-8& $>*9>$>2>8S

6"o' !our debts and ot"er liabilities on t"e dates in eac" of t"e columns belo'% &ist t"em b! categor! suc" as mortgages, c"arges, liens, notes, credit cards, and accounts a!able% -on(t forget to include* an! mone! o'ed to t"e Canada Revenue Agenc!; B

B B

contingent liabilities suc" as guarantees or 'arranties given b! !ou (but indicate t"at t"e! are contingent); and an! un aid legal or rofessional bills as a result of t"is case%

*mount #winA CateAory +ortAaAe, Joint $ine of Credit, Joint Credit Card, Joint 5etails +eridian Credit ?nion, I// 0 +eridian Credit ?nion, I%%%3/ 0 Capital #ne +astercard B on date of marriaAe on 6aluation date 133333.33 B / 33.33 3333.33 today 133333.33 / 33.33 3333.33

%3. 2#2*$ #F 5892S *(5 #2-8& $>*9>$>2>8S B

F1R ()'( -February (. 23(3/

13' 33.33 B

13' 33.33
,age C o! (3

Form 13.1:

Financial Statement (Property and Support Claims)

(paAe ))

Court !ile number

8rror: &eference source not found

P*&2 0: P&#P8&2E, 5892S *(5 #2-8& $>*9>$>2>8S #( 5*28 #F +*&&>*=8

6"o' b! categor! t"e value of !our ro ert!, debts and ot"er liabilities, calculated as of t"e date of !our marriage% (In t"is art, do not include t"e value of a matrimonial "ome or debts or ot"er liabilities directl! related to its urc"ase or significant im rovement, if !ou and !our s ouse ordinaril! occu ied t"is ro ert! as !our famil! residence at t"e time of se aration%)

CateAory and details

1and

Falue on date of marriaAe *ssets B

B

$ia;ilities 3.33

:eneral $ouse$old items > #e$i les

B B 1 33.33 B B B B B B 1 33.33 B 1 33.33 B 13!333.33 B

9ank a ounts. sa#ings. se urities > pensions

1i!e > disability insuran e

9usiness interests

B B B B B 2#2*$S B
(From t"e total of t"e 9Assets: column, subtract t"e total of t"e 9&iabilities: column%) B

Money o&ed to you

Ot$er property (6 ecif!%)

+ebts and ot$er liabilities (6 ecif!%)

%/. (82 F*$?8 #F P&#P8&2E #<(85 #( 5*28 #F +*&&>*=8

% . F*$?8 #F *$$ 585?C2>#(S (Add items J%3K and J%/K'/ B P*&2 ': 8CC$?585 P&#P8&2E

6"o' b! categor! t"e value of ro ert! o'ned on t"e valuation date t"at is e#cluded from t"e definition of 9net famil! ro ert!: (suc" as gifts or in"eritances received after marriage)%

CateAory >n"eritance &oyal 5alton Collection

5etails B

Falue on 6aluation date 1%333.33

%0. 2#2*$ F*$?8 #F 8CC$?585 P&#P8&2E B

1%333.33

F1R ()'( -February (. 23(3/

,age D o! (3

Form 13.1:

Financial Statement (Property and Support Claims)

(paAe !)

Court !ile number

8rror: &eference source not found

P*&2 ): 5>SP#S85.#F P&#P8&2E

6"o' b! categor! t"e value of all ro ert! t"at !ou dis osed of during t"e t'o !ears immediatel! statement, or during t"e marriage, '"ic"ever eriod is s"orter% receding t"e ma7ing of t"is

CateAory

5etails B

Falue

%'. 2#2*$ F*$?8 #F 5>SP#S85.#F P&#P8&2E B P*&2 !: C*$C?$*2>#( #F (82 F*+>$E P&#P8&2E 5eductions Falue of all property owned on 6aluation date (from item J%%K above) Su;tract 6alue of all deductions (from item J% K above) B Su;tract total 6alue of e4cluded property (from item J%0K above) B B 13!333.33 B 1%333.33 B

9*$*(C8 1'3333.33 01333.33 /!333.33 /!333.33

%). (82 F*+>$E P&#P8&2E B

NOTE: T"is financial statement must be u dated no more t"an B1 da!s before an! court event b! eit"er com leting and filing*

@ @

a ne' financial statement 'it" u dated information, or an affidavit in Form /8A setting out t"e details of an! minor c"anges or confirming t"at t"e information contained in t"is statement remains correct%

S&orn6*!!irmed be!ore me at in on t"e Pro6ince of #ntatio

&eAional +unicipality of (iaAara

munici alit! rovince, state or countr! 6ignature (T"is form is to be signed in front of a la'!er, Austice of t"e eace, notar! ublic or commissioner for ta7ing affidavits%)

%1/3%/%31/
date Commissioner for ta7ing affidavits (T! e or rint name belo' if signature is illegible%)

F1R ()'( -February (. 23(3/

,age E o! (3

Sc"edule *: *dditional Sources of >ncome

$ine 1. %. 3. /. . 0. Net partners$ip in ome Net rental in ome -:ross annual rental in ome o! 7 / Total amount o! di#idends re ei#ed !rom ta"able Canadian orporations Total apital gains -7 / less apital losses -7 / Registered retirement sa#ings plan &it$dra&als *ny ot$er in ome (s ecif! source) Su;total: >ncome Source B B B B B B B *nnual *mount

Sc"edule 9: Special or 84traordinary 84penses for t"e C"ild(ren)

C"ildLs (ame 1. %. 3. /. . 0. '. ). !. 10. 84pense B B B B B B B B B B 2otal (et *nnual *mount 2otal (et +ont"ly *mount *mount/yr. B B B B B B B B B B B B *6aila;le 2a4 Credits or 5eductionsM

* Some of these expenses can be claimed in a parents income tax return in relation to a tax credit or deduction (for example childcare costs). These credits or deductions must be shown in the above chart. I atta $ proo! o! t$e abo#e e"penses' I earn 7 per year &$i $ s$ould be used to determine my s$are o! t$e abo#e e"penses'

(#28: ,ursuant to t$e C$ild Support :uidelines. a ourt an order t$at t$e parents o! a $ild s$are t$e osts o! t$e !ollo&ing e"penses !or t$e $ild: . . . . . Ne essary $ild are e"penses% Medi al insuran e premiums and ertain $ealt$0related e"penses !or t$e $ild t$at ost more t$an 7(33 annually% E"traordinary e"penses !or t$e $ild<s edu ation% ,ost0se ondary s $ool e"penses% and. E"traordinary e"penses !or e"tra urri ular a ti#ities'

F1R ()'( -February (. 23(3/

,age (3 o! (3