Form 12—Final Statement of Receipts and Disbursements (Other than Summary Administration and Consumer Proposals)

For persons to which the 2009 amendments do not apply

PDF version

Form 12

35 KB, 4 pages

(Section 152 of the Act)


(Title Form 1)

Trustee's Statement of Receipts and Disbursements

Receipts:
1. Cash in hand and in bank.
$Space to insert cash in hand and in bank
2. Realization of assets: Book debts and bills of exchange.
Space to insert Book debts and bills of exchange
3. Realization of assets: Stock, fixtures, machinery and furniture.
Space to insert Stock, fixtures, machinery and furniture
4. Realization of assets: Real property or immovable.
Space to insert Real property or immovable
5. Received from
a) Interim receiver as taxed
$Space to insert Interim receiver as taxed
b) Former trustee as taxed
Space to insert Former trustee as taxed
$Space to insert total of both interim received and former trustee as taxed
6. Operating receipts:
Space to insert Operating receipts
less:
(a) purchases
Space to insert receipts less expenses
 
(b) operating expenses
Space to insert operating expenses
Space to insert operating and purchases expenses
 
(Attach statement detailing purchases and expenses)
Net profit (Net loss to be shown in miscellaneous disbursements, 19(a))
Space to insert net profit
7. Miscellaneous:
(a) Bank interest, etc. (Specify).
Space to insert Bank interest, etc.
(b) Funds received from guarantor (if applicable).
Space to insert Funds received from guarantor
Total Receipts:
$Space to insert total receipts

Disbursements
8. Fees paid:
(a) To official receiver
$Space to insert fees paid to official receiver
(b) To court
Space to insert fees paid to court
$Space to insert fees paid to official receiver
9. Notice of first meeting:
Local Paper
Space to insert notice of first meeting (local paper)
To (Number) Space to insert number of creditors creditors
Space to insert notice of first meeting (to number of creditors)
Postage
Space to insert insurance
Space to insert insurance
10. Other advertising
Space to insert other advertising
11. Stocktaking and possession (Actual expenses only)
Space to insert stocktaking and possession (actual expenses only)
12. Premiums:
(a) Bond or Suretyship Premium
Space to insert bond or suretyship premium
(b) Insurance
Space to insert insurance premiums
Space to insert total premiums
13. Notice of bankrupt's application for discharge:
To (Number) Space to insert number of creditors (Notice of bankrupt's application for discharge) creditors
Space to insert
Postage
Space to insert postage fees for Notice of bankrupt's application for discharge
Space to insert total amounts of Notice of bankrupt's application for discharge
14. Auctioneer:
Commission
Space to insert commission for auctioneer
Expenses
Space to insert auctionner's expenses
Space to insert commission and Expenses for auctioneer
15. Notice of final dividend and trustee's application for discharge:
To (Number) Space to insert number of notices to creditors creditors
Space to insert fees for Notices of final dividend and trustee's application for discharge
Postage
Space to insert postage fees for notices of final dividend and trustee's application for discharge
Space to insert
16. Other notices and reports:
To (Number) Space to insert number of Other notices and reports creditors.
Space to insert fees for Other notices and reports
Postage
Space to insert fees for postage to other notices and reports
Space to insert total fees of other notices and reports
17. Postage on general correspondence
Space to insert fees for postage on general correspondence
18. Inspector:
(a) Fees (Give details).
Space to insert Inspector's fees
(b) Expenses.
Space to insert Inspector's expenses
Space to insert total of all fees and expenses for inspector
19. Miscellaneous:
(a) Loss on operations
$Space to insert amount of loss on operations
(b) Cost of former trustee as taxed
Space to insert Cost of former trustee as taxed
(c) (Itemize)
Space to insert itemized fees
$Space to insert total of miscellaneous
20. Trustee's remuneration.
Space to insert Trustee's remuneration
21. Legal fees and legal services costs (taxed):
(a) Legal Counsel on application or assignment:
Space to insert Legal Counsel on application or assignment fees
(b) Legal Counsel to estate
Space to insert Legal Counsel to estate fees
(c) Court fees awarded against trustee:
Space to insert Court fees awarded against trustee
(d) Costs awarded to opposing creditor
(pursuant to subsection 197(6.1))
Space to insert costs awarded to opposing creditor
Space to insert total of Legal fees and legal services costs
22. Taxes (Federal and Provincial)
Space to insert Taxes (federal and provincial)
23. Counselling fees
Space to insert Counselling fees
24. Trust claim (Crown)
Space to insert trust claim
total disbursements:
$Space to insert total disbursements
25. Amount available for distribution.
Space to insert Amount available for distribution
26. Levy payable under section 147 of the Act
$Space to insert Levy payable under section 147 of the Act
27. Secured creditors:
Dividend $Space to insert Secured creditors dividend
less levy
Space to insert levy of secured creditors
Space to insert total secured creditors net dividend
28. Preferred creditors:
Dividend Space to insert Preferred creditors dividend
less levy
Space to insert Preferred creditors levy
Space to insert Preferred creditors net dividend
29. Unsecured creditors:
Proved claims of $Space to insert unsecured creditors proved claims
Interim
dividend Space to insert Unsecured creditors interim dividend as percentage% $Space to insert Unsecured creditors interim dividend as fee
less levy
Space to insert space to insert unsecured creditors interim levy
Space to insert unsecured creditors interim net dividend
Final
Dividend Space to insert unsecured creditors final dividend as percentage% $Space to insert unsecured creditors final dividend
less levy
Space to insert unsecured creditors levy
Space to insert total unsecured creditors final dividends
30. Status of Bankrupt's Discharge (if an individual)
Space to insert Status of Bankrupt's Discharge
(Give the description and value of all property of the bankrupt (whether or not secured) as shown in the statement of affairs or otherwise known and not accounted for in the receipts, stating why the property has not been sold or realized and stating the disposition made)
Space to insert date of final statement of receipts and disbursements
Date
Space to insert trustee's signature
Trustee
Approved by the following inspectors:
First space to insert inspector's signature
Second space to insert inspector's signature
Third space to insert inspector's signature
Fourth space to insert inspector's signature
Fifth space to insert inspector's signature
Taxed at the sum of $Space to insert sum of taxes, thisSpace to insert day of month day of Space to insert month Space to insert year.
Space to insert registrar's signature
 
 
Registrar

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