199, , NIL NIL 209, NIL

Transcription

1 To the Bankrupt: STATEMENT OF AFFAIRS (Sec 158) You are required to carefully and accurately complete this form and the applicable attachments, showing the state of your affairs on the date of your bankruptcy, April 16, When completed, this form and the applicable attachments will constitute your Statement of Affairs and must be verified by oath or solemn declaration: Liabilities (as stated and estimated by bankrupt) 1. Unsecured creditors as per list A' Secured creditors as per list 'B' Preferred creditors as per list 'C' Contingent or other liabilities as per list 'D' estimated to be reclaimable for... Total Liabilities. Surplus , , , Assets (as stated and estimated by bankrupt) 1. Inventory... 5, Trade fixtures, fittings, utensils, etc Accounts Receivable, etc. as per list 'E' Good... 10, Doubtful... Bad... Estimated to produce... 5, Bills of exchange, promissory notes, etc. as per list'p Deposits in Financial Institutions Cash Livestock Machinery, equipment and plant Real property or immovable as per list 'G' Furniture RRSPs, RRIFs, Life Insurance, etc Securities (Shares, bonds, debentures, etc) Interest under wills Vehicles Other Property... If Bankrupt is a Corporation add: Amount of capital subscribed Amount paid thereon Balance subscribed and unpaid Estimated to produce Total Assets... Deficiency... 10, , I, Douglas Stanmore President of Century Home Oxygen & CPAP Inc., do swear that this statement and attached lists are to the best of my knowledge a full, true and complete statement of its affairs on April 16, 2009, and fully disclose all property of every description, that is in its possession or that may devolve on it in accordance with Section 67 of the Act. the Province of of Ontario this 16th

2 List 'A' Unsecured Creditors No Name Address Account No. Amount of claim 1 American Express c/o Total Credit Recovery Limited 225 Yorkland Blvd. Toronto ON M2J 4Y7 12, Business Development Bank of Canada 150 King Street West Suite 100 Toronto ON M5H 1J9 95, Canada Revenue Agency - London TSO Revenue Collections Division Regional Intake Centre for Insolvency 451 Talbot Street, 3rd Floor London ON N6A 4R3 Unknown 4 Douglas Stanmore Allan Lipman Lipman Zener & Waxman LLP 1220 Eglinton Avenue West Toronto ON M6C 2E3 80, Leonard and Elizabeth Stanmore Allan Lipman Lipman Zener & Waxman LLP 1220 Eglinton Avenue West Toronto ON M6C 2E3 58,000 Linde Linde Central Customer Service Centre 5860 Chedworth Way Mississauga ON L5R OA2 1, ScotiaLine visa 284 Queen Street East Brampton ON L6V 1C , , Dated: April 16, 2009 Signature of Bankrupt or (

3 OF THE TOWN OF RICHMOND HILL, EN THE PROVINCE OF ONTARIO List 'B' Secured Creditors o Name & Address Amount When Estimated Estimated Balance Nature of Claim of Claim Given Value of Surplus from of Claim Particulars of Security Security Security Unsecured 1 Business Development Bank of Canada 150 King Street West Suite 100 Toronto ON M5H 1J9 Account Receivable Cash in Bank Inventory Office Furniture and Equipment 105, , , "TOTAL* ated: April 16, , ~ ^. \^. '"' 95,399.00

4 List 'C' Preferred Creditors for Wages, Rent, Etc. Name of Creditor Nature of Claim Period During Amount Amount Ranki Address and Occupation Which Claim of Payable f Accrued Claim in Full Divide Ben Walker Limited 150 Consumers Road Suite 207 North York ON M2J 1P9 / Unknown Unknown TOTAL* April 16,2009 C"^. 0.00

5 List 'D' Contingent or Other Liabilities No Name of Creditor or Claimant Amount of Amount Expected DateLiab Nature of Li ability Address and Occupation Liability to Rank for Incurred or Claim Dividend Mo Yr *TOTAL* $0.00 ) Dated: April 16, / ^^"^-^ ') < ^=,^- ^^^^-~ -=======-..,...

6 List 'E' Debts Due to the Estate Name, Address & Nature of Debt Amount Occupation of Debtor of Debt Particulars of Security Good Doubtful Folio Ledger for Particulars Bad Contracted Yr Mo Estimated to Produce Account Receivable 10, , *TOTAL* April 16, ,000,00

7 List 'F' Bills of Exchange, Promissory Notes, Lien Notes Chattel Mortages, etc., Available as Assets ki Name of all Promissors, Amount of Date Estimated Particulars Acceptors, Endorsers, Bill or When Due to Produce held as Security for Paym Mortgagors and Guarantors Note of Bills or Notes Address and Occupation *TOTAL* $0.00 ^-7 ated: April 16, 2009

8 List 'G' Real Property or Immovable Owned by Description of Property Nature of's Interest In Whose Name Does Tide Stand Total Value Particular of Mortgages, Hypothecs or other Encumbrances Name & Address Amount Equity 0.00 *TOTAL* » id: April 16, 2009

9 List 'H' Property Give full particulars of property of every description that is in the bankrupt's possession, or that may devolve on the bankrupt in accordance with section 67 of the act and that are not included in any other list. Nature of Property Location Details of Property Original Cost Estimated to Produce (a) Stock-in-Trade (b) Trade fixtures, etc. (c) Cash in financial institutions (d) Cash on hand (e) Livestock (f) Machinery, equipment and plant (g) Furniture Inventory (encumb.) Cash in Bank (encumb.) Office Furniture and Equipment (encumb.) 72, , , (h) Life insurance policies, RRSPs, etc. (i) Securities (j) Interests under wills, etc. (k) Vehicles (1) Taxes (m) Other property *TOTAL* 5, Dated: April 16, 2009

10 Registry # Bankruptcy No. Of the Town of Richmond Hill, In the Province of Ontario Statement of Affairs and Schedules (Form 74) The Fuller Landau Group Inc. Trustee in Bankruptcy 151BloorSt.West 12th Floor Toronto ON, M5S 1S4 Tel: (416) ATTENTION: Jerry Henechowicz