Declaration of Assets: Please indicate or for each type of asset and attach required documents: “yes” “no” Answer or “yes” “no” IF “YES” for each type of TYPE OF ASSET holder’s Name(s): PROVIDE A COPY OF income Yes____ No___ Yes____ No___ The last 90 days of Bank Accounts transactions for all Yes____ No___ bank/trust/credit union accounts. Yes____ No___ Yes____ No___ Term Deposits/Bonds/ Source Document(s) Debentures Yes____ No___ Stocks/Shares/ GICs Yes____ No___ Mutual Funds/ Source Document(s) Securities/Annuities Yes____ No___ Retirement Savings Yes____ No___ Plan(s) Source Document(s) (registered/unregistered) Yes____ No___ Life Insurance Yes____ Source Document(s) Yes____ No___ Interest/Equity in a Source Document(s) Business or Investment Yes____ No___ Yes____ No___ Taxi Plate(s) and Taxi Source Document(s) Licenses Yes____ No___ Real Property Yes____ No___ (House/Cottage and/or Source Document(s) Land) Yes____ No___ Yes____ No___ Other Asset(s) Source Document(s) See page 10 for examples Yes____
Declaration of Assets: Please indicate “yes” or “no” for each type of asset and attach required documents: TYPE OF ASSET Answer “yes” or “no” for each type of income holder’s Name(s): IF “YES” PROVIDE A COPY OF Bank Accounts Yes____ No___ Yes____ No___ Yes____ No___ Yes____ No___ The last 90 days of transactions for all bank/trust/credit union accounts. Term Deposits/Bonds/ Debentures Yes____ No___ Yes____ No___ Source Document(s) Stocks/Shares/ GICs Mutual Funds/ Securities/Annuities Yes____ No___ Yes____ No___ Source Document(s) Retirement Savings Plan(s) (registered/unregistered) Yes____ No___ Yes____ No___ Source Document(s) Life Insurance Yes____ Source Document(s) Interest/Equity in a Business or Investment Yes____ No___ Yes____ No___ Source Document(s) Taxi Plate(s) and Taxi Licenses Yes____ No___ Yes____ No___ Source Document(s) Real Property (House/Cottage and/or Land) Yes____ No___ Yes____ No___ Source Document(s) Other Asset(s) See page 10 for examples Yes____ No___ Yes____ Source Document(s)
2016-08-15_HDN2015-215_%20Attachment%20Income%20Assets%20Review%20Form.docx