Form FL-24

[Rule 12.50[3]]

COURT FILE NUMBER Clerk’s Stamp

COURT COURT OF QUEEN’S BENCH

OF ALBERTA

JUDICIAL CENTRE

SPOUSE 1

SPOUSE 2

DOCUMENT AFFIDAVIT OF APPLICANTS

[JOINT]

ADDRESS FOR SERVICE AND

CONTACT INFORMATION OF
SPOUSE 1

ADDRESS FOR SERVICE AND

CONTACT INFORMATION OF
SPOUSE 2

Affidavit of [name of Spouse 1 and Spouse 2]

Sworn (or Affirmed) on [date], 20[year]

We, [Name of Spouse 1], of [city/town], Alberta, and [Name of Spouse 2], of [city/town], Alberta, severally
swear/affirm:

PARTIES

1. I am the spouse of the other Applicant. The addresses for the Applicants are:

(a) for Spouse 1: [address]; and,

(b) for Spouse 2: [address]

MARRIAGE

2. I was married to the other Applicant, on [date] at [city, province, and country (if not Canada)], and
attached hereto and marked Exhibit to this Affidavit is a certified copy of a Marriage
Certificate issued by which accurately sets forth the particulars of our marriage.

[If a marriage certificate cannot be obtained, or if the marriage took place outside of Canada, then
the marriage must be proved by setting out the circumstances of the marriage, using the following
paragraph:
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3. I was married to the other Applicant [date], at [city, province, and country (if not Canada)], and
attached hereto and marked as Exhibit to this my Affidavit is a copy of the [marriage licence
or certificate from a religious marriage ceremony or marriage certificate from a jurisdiction outside
Canada]. The other Applicant and I were married in [location] before [name of officiant], a [title]
who I understand had authority to perform a marriage in the jurisdiction where we married. There
were two witnesses, namely [full name] and [full name]. During the ceremony, the other Applicant
and I exchanged promises to live together as spouses, and were pronounced to be spouses.
After the ceremony, the other Applicant and I lived together as spouses and considered ourselves
to be legally married under the law and held ourselves out to the community as legally married.

[It is expected that marriage certificates for marriages performed within Canada will be obtained.]

RESIDENCE

3. I have been ordinarily resident in the Province of Alberta for a period of at least one year
immediately preceding the date of the issuance of the Joint Statement of Claim for Divorce
herein.

[If one party has not been ordinarily resident in Alberta for at least one year preceding the
issuance of the Joint Statement of Claim for Divorce, use “Spouse 1 / Spouse 2 has”.]

GROUNDS

4. There has been a marriage breakdown which is evidenced by the following:

I separated from the other Applicant on [date] at [city/town], in [province], and have lived separate
and apart from the other Applicant since that date, which is a period in excess of one year.

BARS TO DIVORCE

5. I have not entered into any agreement or conspiracy either directly or indirectly for the purpose of
subverting the administration of justice, nor have I entered into any agreement, understanding, or
arrangement to fabricate or suppress evidence or to deceive the Court in this action;

CHILDREN, CHILD CARE AND FINANCIAL ARRANGEMENTS FOR CHILDREN

6. There are children of the marriage, as defined by the Divorce Act (Canada), namely:

(List all dependent children involved in this proceeding, even if no claims are being made in
relation to those children.)

(a) [name] , born [date of birth], living with [name, relationship to child], at [city, province and
country where child resides];
(b) [name] , born [date of birth], living with [name, relationship to child], at [city, province and
country where child resides];

7. There are in existence the following Court Orders from the Court of Queen’s Bench of Alberta, the
Provincial Court of Alberta or any other jurisdiction relating to the children of the marriage:

And attached hereto and marked Exhibit to this Affidavit is a copy of all such Orders.

8. There are in existence the following agreements between the parties or with a third party relating
to the children of the marriage:

Agreement [dated], clauses of which relate to the children.

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Attached hereto and marked Exhibit to this Affidavit is a copy of all agreements between
the parties or with a third party relating to the children of the marriage.

[if applicable, insert: except Minutes of Settlement pertaining to settlement of this action].

[Note: It is optional to attach Minutes of Settlement which pertain to the settlement of the action. If
the Minutes of Settlement have not been attached, details of the provisions relating to the children
should be described in the list above].

9. The other Applicant and I have agreed on a parenting arrangement as follows:

[specify parenting arrangement]

10. The following arrangements have been made for the support of the children of the marriage and it
is my belief that these arrangements are reasonable arrangements as required by paragraph
11[1](b) of the Divorce Act [Canada]:

(a) the amount of $ per month will be paid by for the support of the children of
the marriage;

(b) in addition to any payments made to date, the payments of the amount referred to in
subclause (a) will or did commence on [date].

11. In support of the arrangements referred to in clause 10 the following information is provided:

(a) the guideline income of Spouse 1 is determined as follows:

(i) employment income of $ annually;

(ii) income from other sources of $ ;
(iii) for a total income of $ ;
(iv) minus the following adjustments permitted under Schedule III of the Federal
Child Support Guidelines: ;
(v) for a guideline income of $ .

(b) the guideline income of Spouse 2 is determined as follows:

(i) employment income of $ ;
(ii) income from other sources of $ ;
(iii) for a total income of $ ;
minus the following adjustments permitted under Schedule III of the Federal
Child Support Guidelines:
(iv) ;
(v) for a guideline income of $

(c) the amount of child support payable by under the Federal Child Support Guidelines
is $ ;

(d) special or extraordinary expenses allowable under the Federal Child Support Guidelines
are:

(i) $ per year babysitting/daycare costs;

(ii) $ per year medical/dental insurance premiums related to the children;
(iii) $ per year health related expenses in excess of $100.00;
(iv) $ extraordinary school expenses;
(v) $ post-secondary school expenses;
(vi) $ extraordinary expenses for extracurricular activities.
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IMPORTANT NOTE:

When no expenses are claimed for babysitting/daycare costs and the parent with whom the children live
works outside the home, please explain why no claim is being made for babysitting/daycare. The
explanation will help reduce the likelihood that the application will be returned with a request for more
information.

OR

(d) there are no special or extraordinary expenses being claimed at this time;

(e) [Spouse 1 / Spouse 2 / Both parties] will provide medical and dental insurance coverage
available through employment for the children;

[Additional provisions under the Federal Child Support Guidelines]

(f) provisions for children over the age of majority are: [specify]

(g) split custody; [specify]

(h) shared custody; [specify]

(i) there has been a deviation from the Federal Child Support Guidelines for the following
reasons: [include all relevant information to substantiate the deviation and, if undue
hardship is claimed, state that it is claimed, what it is, and set out the standard of living
test]

12. In support of arrangements referred to above, the source of my knowledge in regard to the above
information relating to the other Applicant is as follows: [specify]

SPOUSAL MAINTENANCE

13. The following arrangements have been made for spousal maintenance:

The other Applicant and I have, by agreement, waived all spousal maintenance claims we may
have against each other, and each party has had independent legal advice with respect to that
agreement.

OR

[Spouse 1 / Spouse 2] will pay spousal support to [Spouse 2 / Spouse 1] as follows:

[specify]

OR

No application for spousal support is being made at the present time.

RECONCILIATION

14. There is no possibility of reconciliation between the other Applicant and me.
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STATEMENT OF CLAIM FOR DIVORCE

15. I have read the Joint Statement of Claim for Divorce filed herein and the information contained
therein is correct except where otherwise stated in this Affidavit.

OR

15. I have read the Joint Statement of Claim for Divorce filed herein and the following things need to
be corrected:
[indicate specific corrections required]

Subject to these corrections, the information contained in the Joint Statement of Claim for Divorce
is correct.

RELIEF REQUESTED

16. This Affidavit is made in support of an application for:

(a) a divorce judgment;

(b) an order for a parenting arrangement as set out above;
(c) an order for child support as set out above;
(d) an order for spousal support as set out above;
(e) an order that [Spouse 1 / Spouse 2 / both parties] maintain the health coverage available
through employment for the children of the marriage;
(f) [add such other relief as required];
(g) [address costs].

SWORN (OR AFFIRMED) BEFORE ME at )

)
, Alberta, this day of , )
)
20 . )
)
)
___________________________________ ) _________________________________
Commissioner for Oaths in and for the ) Signature of Spouse 1
Province of Alberta )
)
)
SWORN (OR AFFIRMED) BEFORE ME at )
)
, Alberta, this day of , )
)
20 . )
)
)
____________________________________ ) _________________________________
Commissioner for Oaths in and for the ) Signature of Spouse 2
Province of Alberta