Disclosure Statement Form - Court Of Queen'S Bench Of Alberta
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1COURT FILE NUMBER
__________________
COURT
COURT OF QUEEN’S BENCH OF ALBERTA
JUDICIAL CENTRE OF
__________________
PLAINTIFF/Applicant
___________________________________
DEFENDANT/Respondent
___________________________________
DOCUMENT
DISCLOSURE STATEMENT
ADDRESS FOR SERVICE
_______________________________________
AND CONTACT INFORMATION
_______________________________________
OF PARTY FILING THIS
____________________________, Alberta
DOCUMENT
_______________________________(phone/email address)
I, ___________________, of ____________, Alberta, SWEAR/AFFIRM AND SAY THAT:
1.
(a) I am not required to file financial information at this time, because my income information
is not necessary for the determination of child support in the order I am seeking.
(b) I am required to file financial information because one or more of the following
circumstances apply:
i)
custody/parenting is shared or split with the other parent;
ii) there are special or extraordinary expenses being paid or claimed;
iii) I am the payor of child support;
iv) other ____________________________________ (specify)
2.
I have filed my financial information with the Court in the last 3 years and:
(a) My Affidavit/Disclosure Statement/Financial Statement (circle that which applies) filed on
________________(date) contains the most recent financial information that I have, OR
(b) I am updating/completing the financial information previously filed.
3.
I am attaching the following schedule:
Schedule 1, as I am either making or responding to an application concerning child support
under the Divorce Act.
Schedule 2, as I am either making or responding to an application concerning child support
under the Family Law Act.
Schedule 3, as I have been served with a Notice to Disclose or am filing a Notice to Disclose.
Schedule 4, as I have been served with a Request for Financial Disclosure.
Schedule 5, which provides updates to my financial information since my previous filing.
No Schedule, by reason of 1(a) above or 2(a) above.
4.
I expect my gross annual income in this calendar year to be $________________________.
Currently I earn income from _________________________________________________.
(indicate source of income)
SWORN (OR AFFIRMED) BEFORE ME at
__________, Alberta, this ____ day of
___________, 20____.
A Commissioner for Oaths in and for the Province of Alberta
[Applicant/Respondent]
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