Form 8 "Financial Statement" - Nunavut, Canada

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FORM 8
IN THE NUNAVUT COURT OF JUSTICE
_______________________
VS
_______________________
FINANCIAL STATEMENT
I, ___________________________, of the __________of ___________________, in the
________________________________,
MAKE OATH AND SAY AS FOLLOWS:
1.
The particulars of my income and expenses are accurately set out below:
MONTHLY INCOME
INCOME
Total gross income from all sources ………………………………………………...______________
Northern Allowance ……………………………………………………………………______________
Child tax benefit ………………………………………………………………………._______________
Pension(specify) ………………………………………………………………………_______________
Worker’s Compensation …………………………………………………………….._______________
Social assistance …………………………………………………………………….________________
Investments …………………………………………………………………………..________________
Other (specify) ……………………………………………………………………….________________
$ 0
Total income ………………………………………………………………………….________________
DEDUCTIONS
Income tax ……………………………………………………………………………________________
Payroll tax ……………………………………………………………………………________________
Union dues …………………………………………………………………………..________________
Unemployment insurance ………………………………………………………….________________
Pension plans ……………………………………………………………………….________________
Canada Pension Plan ………………………………………………………………________________
Payroll savings ………………………………………………………………………________________
Dental plan, insurance and charities (specify) …………………………………..________________
Superannuation ……………………………………………………………………._________________
Other (specify) ………………………………………………………………………________________
$ 0
Total deductions ……………………………………………………………………_________________
Total monthly net income
$ 0
(Total income less total deductions) ……………………………………………._________________
ACTUAL MONTHLY EXPENSES
HOUSING
Rent or mortgage ……………………………………………………………….___________________
FORM 8
IN THE NUNAVUT COURT OF JUSTICE
_______________________
VS
_______________________
FINANCIAL STATEMENT
I, ___________________________, of the __________of ___________________, in the
________________________________,
MAKE OATH AND SAY AS FOLLOWS:
1.
The particulars of my income and expenses are accurately set out below:
MONTHLY INCOME
INCOME
Total gross income from all sources ………………………………………………...______________
Northern Allowance ……………………………………………………………………______________
Child tax benefit ………………………………………………………………………._______________
Pension(specify) ………………………………………………………………………_______________
Worker’s Compensation …………………………………………………………….._______________
Social assistance …………………………………………………………………….________________
Investments …………………………………………………………………………..________________
Other (specify) ……………………………………………………………………….________________
$ 0
Total income ………………………………………………………………………….________________
DEDUCTIONS
Income tax ……………………………………………………………………………________________
Payroll tax ……………………………………………………………………………________________
Union dues …………………………………………………………………………..________________
Unemployment insurance ………………………………………………………….________________
Pension plans ……………………………………………………………………….________________
Canada Pension Plan ………………………………………………………………________________
Payroll savings ………………………………………………………………………________________
Dental plan, insurance and charities (specify) …………………………………..________________
Superannuation ……………………………………………………………………._________________
Other (specify) ………………………………………………………………………________________
$ 0
Total deductions ……………………………………………………………………_________________
Total monthly net income
$ 0
(Total income less total deductions) ……………………………………………._________________
ACTUAL MONTHLY EXPENSES
HOUSING
Rent or mortgage ……………………………………………………………….___________________
Property taxes …………………………………………………………………..___________________
Home insurance ………………………………………………………………….__________________
Utilities ( water and power) ………………………………………………………__________________
Heating …………………………………………………………………………….__________________
Repairs and maintenance ……………………………………………………….__________________
Telephone …………………………………………………………………………._________________
Cable television ……………………………………………………………………_________________
TRANSPORTATION ……………………………………………………………..__________________
Gas and oil ………………………………………………………………………..__________________
Insurance and registration ………………………………………………………__________________
Maintenance ………………………………………………………………………__________________
Public transportation ……………………………………………………………..__________________
Other (specify) ……………………………………………………………………__________________
PERSONAL CARE ………………………………………………………………__________________
Health and medical insurance ………………………………………………….__________________
Life Insurance …………………………………………………………………….__________________
Retirement savings plan ………………………………………………………..___________________
Prescriptions …………………………………………………………………….___________________
Dental Care ……………………………………………………………………..___________________
Hairdresser/ barber …………………………………………………………….___________________
Toiletries …………………………………………………………………………___________________
MISCELLANEOUS …………………………………………………………….___________________
Food, groceries and household supplies ……………………………………____________________
Meals outside the home ………………………………………………………____________________
Clothing ……………………………………………………………………….._____________________
Laundry and dry cleaning …………………………………………………….____________________
Alcohol, tobacco (specify) …………………………………………………….____________________
Entertainment …………………………………………………………………..____________________
Vacation savings ………………………………………………………………____________________
Education (school fees) ………………………………………………………____________________
Books …………………………………………………………………………..____________________
Music Lessons ……………………………………………………………….._____________________
Recreation ……………………………………………………………………._____________________
Newspaper publications …………………………………………………….._____________________
Stationery ………………………………………………………………………____________________
Babysitting and daycare ………………………………………………… …____________________
Childrens’ allowance/ gifts ………………………………………………… ____________________
Support payments to other relatives ………………………………………..____________________
Savings for future ……………………………………………………………..____________________
Other (specify) …………………………………………………………………____________________
$ 0
Total actual monthly expenses ……………………………………………____________________
DEBTS
BANK LOANS ( include the following information for every loan)
Name and address of loan holder: __________________________________________________
Amount outstanding ………………………………………………………………__________________
Monthly payments ………………………………………………………………..__________________
Arrears (if any) ……………………………………………………………………__________________
MORTGAGES (include the following information for every mortgage)
Name and address of loan Mortgagee:______________________________________________
Amount outstanding ………………………………………………………………__________________
Monthly payments ………………………………………………………………..__________________
Arrears (if any) ……………………………………………………………………__________________
CREDIT CARDS( include the following information for every creditor)
Name and address of creditor :____________________________________________________
Amount outstanding ………………………………………………………………__________________
Monthly payments ………………………………………………………………..__________________
Arrears (if any) ……………………………………………………………………_________________
OTHER DEBTS
(include the following information for every debt and specify what the debt is for)
Name and address of creditor: ___________________________________
Amount outstanding ...................................................................................... _________________
Monthly payments ......................................................................................... _________________
Arrears (if any) ............................................................................................... _________________
$ 0
Total debts ( Bank loans + mortgages + credit cards + other debts) ………__________________
$ 0
Total amount of debt payable each month …………………………………__________________
NON-MONETARY BENEFITS
Non- monetary benefits received from any source (specify): ______________________________
SUMMARY
$ 0
Total net income …………………………………………………………………__________________
Less:
total actual monthly expenses ……………………………………….___________________
$ 0
Less:
total amount of debt payable each month ………………………….___________________
$ 0
Balance (or deficit) ………………………………………… ………………..___________________
$ 0
2.
The particulars regarding my employment are as follows:
(a) the name and address of my employer is)
(b) I am paid every ___________________________________________________:
(c) The total income declared on my last income tax return in 20___ was $________
And my net taxable income was $ ________________________________________
)
SWORN before me at the __________________
)
of ________________________________ in
)
____________________
__________________________
on __________________________________, 20__ )
(signature of deponent)
(month)
(day)
______________________________________
Commissioner for Oaths/Notary Public
NOTE: This affidavit must be signed before a person authorized to take affidavits by the Evidence Act.
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