C-25.01, r. 6 - Rules of practice of the Superior Court of Québec in family matters

Schedule Disposition versions

2014-07-12

FORM IV

(Revoked)

Decision 91-06-21, s. 5; Decision 94-06-23, s. 34; Decision 98-10-16, s. 3; Decision 2003-06-30, s. 9; Decision 2004-08-31, s. 2; Decision 2014-06-13, s. 2.

2012-09-01

FORM IV

STATEMENT OF THE FAMILY PATRIMONY

(Identification of the record)
STATEMENT OF THE FAMILY PATRIMONY
		

A	APPLICANT	DEFENDANT	
PROPERTY EXCLUDED FROM THE PATRIMONY
(Art. 415 C.C.Q.)	VALUE	VALUE	GROUNDS FOR EXCLUSION
			
			

VALUE OF THE PATRIMONY ESTABLISHED AS AT  ___/_____/_______	 	c  date spouses ceased living together
	DD / MM / YYYY	c	date of institution of the action

B	APPLICANT			DEFENDANT		
NET VALUE OF PROPERTY IN THE PATRIMONY OWNED BY THE PARTIES
(Art. 415 and 417 C.C.Q.)
(1)Family residence
(2)	Secondary residence(s)
(3)	Movable property which furnishes or decorates the residences and serves for the use of the household:
l	Family residence
l	Secondary residence(s)
(4)	Motor vehicle(s) used for family travel
            
 	TOTAL	VALUE	DEBT
INCURRED	NET	VALUE	DEBT
INCURRED	NET
	
$_________ 
$_________ 




$_________ 
$_________ 

$_________ 

$_________ 	
$_________ 
$_________ 




$_________ 
$_________ 

$_________ 

$_________ 	
$_________ 
$_________ 




$_________ 
$_________ 

$_________ 

$_________ 	
$_________ 
$_________ 




$_________ 
$_________ 

$_________ 

$_________ 	
$_________ 
$_________ 




$_________ 
$_________ 

$_________ 

$_________ 	
$_________ 
$_________ 




$_________ 
$_________ 

$_________ 

$_________ 
DEDUCTIONS
(Art. 418 C.C.Q.)			less			less
(a)	Property owned before the marriage	Net value	increase in 
	value
$_________ $ +	_________ 		

=$________ 	Net value	increase in
	value
$_________  +	$_________ 		

=$________ 
(b)	Contribution during the marriage	Contribution	increase in
	value
_________ $ +	_________ $		

=$________ 	Contribution 	increase in
	value
$_________ $ +	$_________ 		

=$________ 
(c)	reinvestment during the marriage						
VALUE WHICH MAY BE PARTITIONED			
=$                 			
=$                 

*If necessary, provide details in a schedule


C	APPLICANT			DEFENDANT		
NET VALUE OF PROPERTY IN THE PATRIMONY OWNED BY THE PARTIES
(Art. 415 and 417 C.C.Q.)

(5)	Benefits accrued during the marriage under a retirement plan (**See Section D if the plan does not confer the right to a capitalized amount)
(6)	RRSPs accrued during the marriage


             TOTAL	VALUE	DEBT INCURRED	NET	VALUE	DEBT INCURRED	NET
	




$_________ 



$_________ 


$_________ 	




$_________ 



$_________ 


$_________	




$_________ 



$_________ 


$_________	




$_________ 



$_________ 


$_________	




$_________ 



$_________ 


$_________	




$_________ 



$_________ 


$_________
DEDUCTIONS
(Art. 418 C.C.Q.)			less			less
Contribution during the marriage	Contribution	increase in
	value
$_________ $ +	$_________ 		

=$________ 	Contribution	increase in
 	value
$_________  +	$_________		

=$________ 
VALUE WHICH MAY BE PARTITIONED			
=$			
=$                 


D Check the appropriate boxes	APPLICANT	DEFENDANT
Registered earning during the marriage:		
l	Québec Pension Plan (Q.P.P.)	c	c
l	Canada Pension Plan (C.P.P.)	c	c
** The pension plan to which you contribute entitles your spouse to a pension instead of a capitalized amount	c	c
** The pension plan to which your spouse contributes entitles you to a pension instead of a capitalized amount	c	c

SWORN STATEMENT
I declare that the information given regarding the property owned by me is accurate and complete and that, to the best of my knowledge, it is accurate and complete as regards the property owned by the other party.
And I have signed in 	, on	
	Applicant c or Defendant c
Solemnly affirmed before me in 	 this	
Individual empowered to receive oaths:				
E I BELIEVE THAT THE RULES REGARDING THE FAMILY PATRIMONY DO NOT APPLY IN THIS CASE, FOR THE FOLLOWING REASONS: (SPECIFY)
				
	
	
	
I AM NEVERTHELESS COMPLETING THE FOLLOWING STATEMENT IN THE EVENT THAT THE COURT DOES NOT ACCEPT THIS ARGUMENT.
F I AM CLAIMING A COMPENSATORY ALLOWANCE FOR THE FOLLOWING REASONS (ART. 421 C.C.Q.):
	
	
	
	
G I AM CLAIMING UNEQUAL PARTITION FOR THE FOLLOWING REASONS (ART. 422 C.C.Q.):
	
	
	
H EFFECTING THE PARTITION (Art. 419 and 420 C.C.Q.)
Proposed methods of payment:
1. 	Currency:
 -	in cash:	$		
 -	by instalments:	$		
 -	as follows:
		(date)	(amount)
					
					
					
-	security (if applicable):
		
		
		
		
2.	By giving in payment of the following property
	Applicant:	Defendant:
		  
		  
		  
		  
I RECOVERY OF DEDUCTIONS (IF APPLICABLE):
	Applicant:	Defendant:
		  
		  
		  
		  
Signed in 		, on			
		
	PER:

Decision 91-06-21, s. 5; Decision 94-06-23, s. 34; Decision 98-10-16, s. 3; Decision 2003-06-30, s. 9; Decision 2004-08-31, s. 2.