Other Public transportation Personal Expenses Other Smoking Insurance Expenses Alcohol Vehicle Dining/lunches/restaurants House Entertainment/sports Furniture/contents Gifts/charitable donations Life insurance Allowances Other Other Payments Non-recoverable Medical Expenses To Trustee Prescriptions To secured creditor (Other than mortgage and vehicle) Dental Other Other TOTAL MONTHLY DISCRETIONARY EXPENSES (D) TOTAL - SURPLUS/(SHORTFALL) (C)-(D) ASSETS DESCRIPTION LOCATION BEST ESTIMATE OF PRESENT VALUE Cash on Hand/In Bank
10. Other TOTAL 109,500.00 106,500.00 0.00 LIABILITIES Liabilities type code (LTC): 1. Real Property or Immovable Mortgage or Hypothec 2. Bank Loans (except real property mortgage) 3. Finance Company Loans 4. Credit Cards Bank/Trust Companies Issuers 5. Credit Cards Other Issuers 6. Taxes Federal/Provincial/Municipal 7. Student Loans 8. Loans from Individuals 9. Other Creditor Address including postal code Account No. Amount of Debt Enter LTC Unsecured Secured Preferred ABC Soup Supplier 3,000.00 0.00 0.00 9 American Express c/o DRN Commerce Inc. P.O. Box 2514, Station B London ON N6A 4G9 40,000.00 0.00 0.00 4 Bank of Nova Scotia c/o P.O. Box 57100 Toronto ON M8Y 3Y2 5,000.00 0.00 0.00 2 Bank of Nova Scotia c/o P.O. Box 57100 Toronto ON M8Y 3Y2 5,000.00 0.00 0.00 2 Canada Revenue Agency Attn: Collections Division London Tax Services Office P.O. Box 5548, 451 Talbot Street London ON N6A 4R3 Personal Income Tax 30,000.00 0.00 0.00 6 Canada Revenue Agency Attn: Collections Division London Tax Services Office P.O. Box 5548, 451 Talbot Street London ON N6A 4R3 GST 10,000.00 5,000.00 0.00 6 Firstline Mortgages #400 – 100 University Avenue Toronto ON M5J 2X4 0.00 100,000.00 0.00 6
10. Other TOTAL 108,001.00 105,000.00 0.00 LIABILITIES Liabilities type code (LTC): 1. Real Property or Immovable Mortgage or Hypothec 2. Bank Loans (except real property mortgage) 3. Finance Company Loans 4. Credit Cards Bank/Trust Companies Issuers 5. Credit Cards Other Issuers 6. Taxes Federal/Provincial/Municipal 7. Student Loans 8. Loans from Individuals 9. Other Creditor Address including postal code Account No. Amount of Debt Enter LTC Unsecured Secured Preferred ABC Soup Supplier 3,000.00 0.00 0.00 9 American Express c/o DRN Commerce Inc. P.O. Box 2514, Station B London ON N6A 4G9 40,000.00 0.00 0.00 4 Bank of Nova Scotia c/o P.O. Box 57100 Toronto ON M8Y 3Y2 5,000.00 0.00 0.00 2 Bank of Nova Scotia c/o P.O. Box 57100 Toronto ON M8Y 3Y2 5,000.00 0.00 0.00 2 Canada Revenue Agency Attn: Collections Division London Tax Services Office P.O. Box 5548, 451 Talbot Street London ON N6A 4R3 GST 10,000.00 5,000.00 0.00 6 Capital One Inc. Attn: C/O DNR Commerce Inc P.O. Box 2514 Station B, London, ON 15,000.00 0.00 0.00 5 EI 3,000.00 0.00 0.00 9
Appendix J: Trustee’s Statement of Receipts and Disbursements re Mrs. Mitchell District of: Ontario Division No. 03 - Court No. 31-0000000 Estate No. 31-0000000 FORM 13 Trustee’s Statement of Receipts and Disbursements (Sections 152, 155 of the Act ; Rule 62) In the matter of the bankruptcy of Mrs. Mitchell (FCOB as the Whistle Stop) A Retiree of the City of Anywhere, in the County of Simcoe, in the Province of Ontario SUMMARY ADMINISTRATION RECEIPTS Voluntary payments $ 875.00 NET RECEIPTS AVAILABLE TO THE ESTATE 875.00 DISBURSEMENTS : Counselling fees : 85.00 Fees paid a) To official receiver 75.00 Administrative Disbursement : 100.00 Trustee’s Fees : 100 % of 875.00 576.90 35 % of 0.00 0.00 50 % of 0.00 0.00 Total Fees 576.90 Fees due 676.90 were limite to funds available in the estate Applicable Taxes (GST) : Taxes on counselling fees 4.25 Taxes on trustee fees and administration fee 33.85 38.10 TOTAL DISBURSEMENTS 875.00 Note : How much of the total disbursements was paid for services provided by persons related to the trustee? 0.00 Amount available for distribution 0.00 Proved Claims 138,000.00 Dividend 0.00 Superintendent’s levy 0.00 TOTAL DIVIDEND AND LEVY 0.00 TOTAL DISTRIBUTED $875.00 Notes : Status of Bankrupt’s Discharge : Automatic on October 2, 20XX.