FORM 70U

File No. FD

SUMMARY OF ASSETS AND LIABILITIES

The King's Bench (Family Division)

Centre

BETWEEN:

(full name),

petitioner,

(initiating/responding party)

— and —

(full name),

respondent.

(initiating/responding party)

SUMMARY OF ASSETS AND LIABILITIES OF

(full name)

I, , of the of ,

(full name)

in the province of , the initiating party/responding party in this reference under The Family Property Act, SWEAR (or AFFIRM) THAT:

1.	To the best of my knowledge, information and belief, the information completed by me in this Summary of Assets and Liabilities, including Parts 1 to 9 attached, is true and complete.

2.	Attached are the following Parts:

ASSETS:

Part 1 — Land

Part 2 — Vehicles

Part 3 — Savings

Part 4 — R.R.S.P.'s, R.S.P.'s and Pension Plans

Part 5 — Securities

Part 6 — General Household Items

Part 7 — Business Interests

Part 8 — Other Property

TOTAL ASSETS:

VALUE (total from Part)

LIABILITIES:

Part 9 — Debts and Other Liabilities	VALUE (total from Part)

OTHER:

Part 10 — Excluded Property

Part 11 — Assets Already Shared

SWORN (or affirmed) before me at the

)
of ,	)
in the Province of Manitoba,	)
this day of , .	)

A Commissioner for Oaths in and for the
Province of Manitoba
My Commission expires:

PART 1 — LAND

(If columns 1 and 2 are completed by initiating party, column 3 must be completed by the responding party and vice versa.)

Columns 1 and 2 completed by: , the initiating/responding party.

(name)

Column 3 completed by: , the initiating/responding party.

(name)

(Include an interest in land owned on the valuation date, including any leasehold interest or mortgage interest. Show estimated fair market value of your interest as at the valuation date. List encumbrances in Part 9 — Debts and Other Liabilities. List land which is jointly owned with the other party in Part 11.)

1	2	3
Legal description and address of property	Fair market value of your interest

as of valuation date

and basis for value	State if you agree or disagree with the value, or require verification of the value.	If you disagree with the value in column 2 state your value and the basis for your value.

TOTAL: $

TOTAL: $

PART 2 — VEHICLES

(If columns 1 and 2 are completed by initiating party, column 3 must be completed by the responding party and vice versa.)

Columns 1 and 2 completed by: , the initiating/responding party.

(name)

Column 3 completed by: , the initiating/responding party.

(name)

(Show fair market value (not cost of replacement or purchase price) for all motor vehicles, including boats and snowmobiles, owned by you or in your possession on the valuation date. Designate the owner, if someone other than yourself, under Column 1. Do not deduct encumbrances here, but list encumbrances under Debts and Other Liabilities. Place an asterisk beside any vehicles which is owned by you but is in the possession of the other party.)

1	2	3
Description of vehicles	Fair market value

as of valuation date

and basis for value	State if you agree or disagree with the value, or require verification of the value.	If you disagree with the value in column 2, state your value and the basis for your value.

TOTAL: $

TOTAL: $

PART 3 — SAVINGS

(If columns 1 and 2 are completed by initiating party, column 3 must be completed by the responding party and vice versa.)

Columns 1 and 2 completed by: , the initiating/responding party.

(name)

Column 3 completed by: , the initiating/responding party.

(name)

(Value assets as at the valuation date by category. Include cash and accounts in financial institutions, deposit receipts and other savings or savings plans but list retirement savings plans and pensions on Part 4. Include the cash value of life insurance policies.)

1	2	3
Description including financial institution and account no.	Fair market value

as of valuation date

and basis for value	State if you agree or disagree with the value, or require verification of the value.	If you disagree with the value in column 2, state your value and the basis for your value.

TOTAL: $

TOTAL: $

PART 4 — R.R.S.P's, R.S.P's and PENSION PLANS

(If columns 1 and 2 are completed by initiating party, column 3 must be completed by the responding party and vice versa.)

Columns 1 and 2 completed by: , the initiating/responding party.

(name)

Column 3 completed by: , the initiating/responding party.

(name)

(List all registered retirement savings plans, retirement savings plans and pensions.)

1	2	3
Description including financial institution and account no.	Fair market value

as of valuation date

and basis for value	State if you agree or disagree with the value, or require verification of the value.	If you disagree with the value in column 2, state your value and the basis for your value.

TOTAL: $

TOTAL: $

PART 5 — SECURITIES

(If columns 1 and 2 are completed by initiating party, column 3 must be completed by the responding party and vice versa.)

Columns 1 and 2 completed by: , the initiating/responding party.

(name)

Column 3 completed by: , the initiating/responding party.

(name)

(Show items owned on the valuation date by category. Include shares, bonds, warrants, options, debentures, notes, and any other securities.)

1	2	3
Description including category and number	Fair market value

as of valuation date

and basis for value	State if you agree or disagree with the value, or require verification of the value.	If you disagree with the value in column 2, state your value and the basis for your value.

TOTAL: $

TOTAL: $

PART 6 — GENERAL HOUSEHOLD ITEMS

(If columns 1 and 2 are completed by initiating party, column 3 must be completed by the responding party and vice versa.)

Columns 1 and 2 completed by: , the initiating/responding party.

(name)

Column 3 completed by: , the initiating/responding party.

(name)

(Show fair market value (not cost of replacement or purchase price) for items owned by you or in your possession on the valuation date. Include all items in your possession or control whether they were in your residence, your cottage property, in storage or elsewhere. Do not deduct encumbrances here, but list encumbrances under Part 9 — Debts and Other Liabilities. Place an asterisk beside any item which is owned by you but is in the possession of the other party.)

1	2	3
Description	Fair market value

as of valuation date

and basis for value	State if you agree or disagree with the value, or require verification of the value.	If you disagree with the value in column 2, state your value and the basis for your value.
(a) Appliances & electronics (include T.V., stereo, computers, cameras, etc.)

(b) Furniture

(c) Tools & garden equipment

(d) Jewellery

(e) Works of art, collections

(f) Books, tapes, CD's, videos

(g) Miscellaneous

(You may indicate a total value for this category without specifying every item.)

TOTAL: $

TOTAL: $

PART 7 — BUSINESS INTERESTS

(If columns 1 and 2 are completed by initiating party, column 3 must be completed by the responding party and vice versa.)

Columns 1 and 2 completed by: , the initiating/responding party.

(name)

Column 3 completed by: , the initiating/responding party.

(name)

(Show the fair market value of any interest you have in any unincorporated or incorporated business as of the valuation date).

1	2	3
Description of Business Interest	Fair market value

as of valuation date

and basis for value	State if you agree or disagree with the value, or require verification of the value.	If you disagree with the value in column 2, state your value and the basis for your value.

TOTAL: $

TOTAL: $

PART 8 — OTHER PROPERTY

(If columns 1 and 2 are completed by initiating party, column 3 must be completed by the responding party and vice versa.)

Columns 1 and 2 completed by: , the initiating/responding party.

(name)

Column 3 completed by: , the initiating/responding party.

(name)

(Show other property owned on the valuation date by categories. Include property of any kind not shown on the previous forms. Include any assets in the form of mere rights, whether present, future or contingent. Include all monies owed to you on the valuation date. Do not include receivables which are accounted for in Part 7 — Business Interests.)

1	2	3
Description	Fair market value

as of valuation date

and basis for value	State if you agree or disagree with the value, or require verification of the value.	If you disagree with the value in column 2, state your value and the basis for your value.

TOTAL: $

TOTAL: $

PART 9 — DEBTS AND OTHER LIABILITIES

(If columns 1 and 2 are completed by initiating party, column 3 must be completed by the responding party and vice versa.)

Columns 1 and 2 completed by: , the initiating/responding party.

(name)

Column 3 completed by: , the initiating/responding party.

(name)

(Show your debts and other liabilities on the valuation date, by category such as mortgages, charges, liens, notes, credit cards, and accounts payable. Include contingent liabilities such as guarantees and indicate that they are contingent. Do not show liabilities already taken into account in determining fair market value under Part 7 — Business Interests.)

1	2	3
Description	Fair market value

as of valuation date

and basis for value	State if you agree or disagree with the value, or require verification of the value.	If you disagree with the value in column 2, state your value and the basis for your value.

TOTAL: $

TOTAL: $

PART 10 — EXCLUDED PROPERTY

(If columns 1, 2 and 3 are completed by initiating party, column 4 must be completed by the responding party and vice versa.)

Columns 1, 2 and 3 completed by: , the initiating/responding

party.	(name)

Column 4 completed by: , the initiating/responding party.

(name)

(Show the fair market value by category of property owned on the valuation date which you allege is excluded from the applicability of The Family Property Act. Include the specific section of The Family Property Act in column 2.)

1	2	3	4
Description	Reason for exclusion and applicable section of The Family Property Act	Fair market value

as of valuation date

and basis for value	State if you agree or disagree with the value, or require verification of the value.	If you disagree with the value in column 3, state your value and the basis for your value.

TOTAL: $

TOTAL: $

PART 11 — ASSETS ALREADY SHARED

(If columns 1 and 2 are completed by initiating party, column 3 must be completed by the responding party and vice versa.)

Columns 1 and 2 completed by: , the initiating/responding party.

(name)

Column 3 completed by: , the initiating/responding party.

(name)

(Include all jointly owned assets and assets which you allege have already been shared.)

1	2	3
Description	Fair market value

as of valuation date

and basis for value	State if you agree or disagree with the value, or require verification of the value. If you disagree with the value in column 2, state your value and the basis for your value.

TOTAL: $

TOTAL: $