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Alla Koren
Barrister & Solicitor
489 Worthington Avenue
Richmond Hill, Ontario
L4E 4R6
Tel: (905) 780-1500
Fax: (905) 773-7906
Toll Free: 1-888-622-7673
Email:alla@allakoren.com







December 12, 2017, 11:35 am

Client's Information
* Full Legal Name
Social Insurance Number
Street Address
City
Province
Postal code
* Email
Home Telephone Number
Work Telephone Number
Cell Number
Employer's Name
Employer's Address
Employer's Phone Number
Full Legal Name
Social Insurance Number
Street
City
Province
Postal code
Email
Home Telephone Number
Work Telephone Number
Cell Number
Employer's Name
Employer's Address
Employer's Phone Number
Spouse's Lawyer (Name, Address and Telephone Number)
Husband
Husband's Date of Birth
Husband is a Resident in (Municipality and Province)
Husband is Resident of Above Since
Husband's Surname at Birth
Husband's Surname Immediately Before Marriage
Marital Status of Husband at Time of Marriage (If Martial Status Was Divorced, Place and Date of Previous Marriage)
Wife
Wife's Date of Birth
Wife is a Resident in (Municipality and Province)
Wife is Resident of Above Since
Wife's Surname at Birth
Wife's Surname Immediately Before Marriage
Marital Status of Wife at Time of Marriage (If Martial Status Was Divorced, Place and Date of Previous Marriage)
Relationship Dates
Married On
Started Living Together On
Never Lived Together
Still Living Together
Started Living Together on Date of Marriage (yes or no)
Separation Date
Reconciliation
Date of Reconciliation
(if any)
Efforts to Reconcile
(if any)

Children's Information
Name Age & Birth date School & Grade or Year With Whom
& Where
Child Resides
  Have you or the children been in a court case before?


When?

Have you made a written agreement dealing with any matter involved in this case?

The custody and access arrangements for the child(ren) are as follows (give summary):
These are the specific arrangements that have been made for the support of the child(ren): The amount of support being paid by is for children.

This arrangement for support is already dealt with by way of:
dated .

The child support clauses of this order/agreement/consent require payment of $ per month in child support.

The child support clauses have been complied with.


Issues in Dispute
Parentage (i.e.,: paternity)
Yes No Not sure
Custody
Yes No Not sure
Access
Yes No Not sure
Child Support
Yes No Not sure
Spousal Support
Yes No Not sure
Restraining Order
Yes No Not sure
Exclusive Possession
of Matrimonial Home
Yes No Not sure
Division of Property
Yes No Not sure
Other
Yes No Not sure
Please provide details below to the relevant issues in dispute.

Custody Disputes

Complete this section ONLY IF CUSTODY IS IN DISPUTE.
Otherwise, click here to continue.

Minor Child (less than 18 years)

Who was the primary care giver of the child/children before separation?

How much time did you spend with the child(ren) compared with your spouse?

Who spent more time with the child(ren) during the weekdays?

Who spent more time with the child(ren) during the weekends?

Who woke up at night to attend to the child(ren)?

Who spent more time taking the child(ren) to the hospital?

Who spent more time preparing food for the child(ren)?

List other ways that you took care of the child(ren). (ex. changing diapers, feeding, bathing, etc.)

Describe your concerns with respect to the parenting skills of your spouse.

List extracurricular activities that the child(ren) is/are involved in.

How will you ensure that the child(ren) continue(s) being involved in the activities.

If the child(ren) is/are not involved in any extracurricular activities - what is your plan?

Describe briefly your love, affection and emotional ties to your child(ren).

Has/Have the child(ren) expressed their wishes with respect to time to be spent with either parent?

Where was/were the child(ren)'s primary residence before separation?

How long did the child(ren) reside there?

How are you able to provide the child(ren) with guidance and education?

What is your level of education?

What is your spouse's level of education?

How are you able to provide for the necessaries of life and any special needs to the child(ren)?

How is your spouse able to provide for the necessaries of life and any special needs to the child(ren)?

Describe in detail your parenting plan with respect to the following:

How much time do you want your spouse to have access to the child(ren) if you have custody.

Facilitating access of other members of the child(ren)'s family who reside with the child(ren).

Facilitating access of person(s) involved in the care and upbringing of the child(ren).

Proposed accommodation for the child(ren), specifying rooms in dwellings, number of people in the dwelling and relationship of the resident(s)' to the child(ren).

Describe the permanence and stability of the family unit within which it is proposed that the child(ren) will live with.

Provide any information that may be used against you as being an unfit parent (i.e., abuse of spouse and/or child(ren), neglect, substance abuse, criminal record or mental health issues.)

Adult Child (over 18 years)
With whom is the child(ren) residing?


What program of study is your child(ren) enrolled in?


When does your child(ren) plan to commence studies, if she/he are not enrolled in one yet?


When does your child(ren) plan to complete his/her study?


Is/Are your child(ren) enrolled in a full time program?


Where will your child(ren) be residing during study periods?


Will your child(ren) be earning an income while attending school?


How much is the cost for tuition and books for your child(ren)?


How much is the cost of your child(ren)'s living expenses?


How much is your child(ren) going to receive from OSAP?


Is/Are your child(ren) dependent on you because of health reasons?


Please specify the health reasons and how they affect your child(ren) from being independent.



Child Support Disputes
Complete this section
ONLY IF CHILD SUPPORT IS IN DISPUTE.
Otherwise, click here to continue.

Financial Information - Income
Your Yearly Gross Income


What is your profession now and during the marriage?


What is your spouse's profession now and during the marriage?


Your Spouse's Gross Income


Does your spouse receive additional income other than business or employment income?


Do you reside with another person who earns an income?


Does your spouse reside with another person who earns an income?


Please indicate which of the following applies to your spouse with respect to his or her income: Your spouse is intentionally under-employed or unemployed, other than where under-employment or unemployment is required by the needs of a child of the marriage or any other child under the age of majority or by reasonable educational or health needs of the spouse.


It appears that income has been diverted which would affect the level of child support to be determined under the Guidelines.


The spouse's property is not properly utilized to generate income.


The spouse unreasonably deducts expenses from income.


The spouse derives a significant portion of income from dividends, capital gains or other sources that are taxed at a lower rate than employment or business income or that are exempt from tax.


The spouse is a beneficiary under a trust and is or will be in receipt of income or other benefits from the trust.


Other Situation(s). Please explain.

Financial Information - Health Coverage
Do you have health coverage?

If yes, who is the provider?

Does your spouse have health coverage?

If yes, who is the provider?  
Financial Information - Special or Extraordinary Expenses
How much are you paying for the following for the child(ren):

Tuition and books  


Child care expenses as a result of custodial parent's employment, illness, disability, education or training for employment  


Portion of medical and dental insurance premiums attributable to the child(ren)  


Health related expenses that exceed insurance reimbursement by at least $100.00 annually, including orthodontic treatment, professional counselling provided by a psychologist, social worker, psychiatrist or any other person, physiotherapy, occupational therapy, speech therapy and prescription drugs, hearing aids, glasses and contact lenses
 

Extraordinary expenses for primary or secondary school education or for any other education programs that meet the child(ren)'s particular needs  


Expenses for post-secondary education  


Extraordinary expenses for extracurricular activities  


Spousal Support Disputes

Complete this section
ONLY IF SPOUSAL SUPPORT IS IN DISPUTE.
Otherwise, click here to continue.
 
What prevents you from being independent?


How has your accustomed lifestyle during marriage changed?


What attempts are you making to make yourself independent, i.e., retraining or going back to school?


If you are retraining or going to school, what is the cost and how long will it take you to become independent?


Does your spouse have another legal obligation to support another person?

How did you contribute to your spouse's realization of his career, business or wealth accumulation?


How long did you cohabit, including the time you cohabitated before marriage?


What was the effect of your spouse's earning capacity on the responsibilities assumed during cohabitation?


Have you undertaken the care of a child who is at least 18 years and unable by reason of illness, disability or other cause to be independent?


Have you undertaken to assist in the continuation of a program of education for a child at least 18 years who is unable for that reason to be independent?


Who performed domestic services in the family? (Explain)


List the time periods that you took time off from full time employment, other than maternity leave, to raise the child(ren)?
 
Provide value for the following assets:
Assets Yours Spouse's
Home
 
Other Real Estate Property & Value
 
General Household Contents
Jewellry
Works of art
Vehicles and boats
Cash
RRSP
Pension
Securities
Life and disability insurance
Accounts receivables
Business interests
Other property
 
Debts
Yours Spouse's
Mortgage on Home
 
Mortgage on Other Property
Credit Cards
Other


Assets and Debts as of Date of Marriage:
Assets / Debts Yours Spouse's
Assets
Debts
  Excluded Property Please indicate if you or your spouse owned the following property on the date of separation, including the value of the property. Property other than the matrimonial home, that you acquired by gift or inheritance from a third person (other than your spouse) after the date of marriage.


Income from property referred to in above, if the donor or testator has expressed in writing that it is to be excluded from the spouse's net family property.


Damages or a right to damages for personal injuries, nervous shock, mental distress or loss of guidance, care and companionship, or the part of a settlement that represents those damages.


Proceeds or a right to proceeds of a policy of life insurance as defined in the Insurance Act, that are payable on the death of the life insured.


Property, other than the matrimonial home, into which property referred to in the above 4 paragraphs can be traced.


Property that the spouses have agreed by domestic contract is not to be included in the spouse's net family property.
 
Your Proposal To Settle