OF THE TOWN OF RICHMOND HILL, IN THE PROVINCE OF ONTARIO
To the Bankrupt:
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, 2009. 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'... 2. Secured creditors as per list 'B'... 3. Preferred creditors as per list 'C'... 4. Contingent or other liabilities as per list 'D'
estimated to be reclaimable for ... Total Liabilities . Surplus ... 199,404.25 10,201.00 NIL NIL 209,605.25 NIL Assets
(as stated and estimated by bankrupt)
1. Inventory... 5,000.00 2. Trade fixtures, fittings, utensils, etc... NIL 3. Accounts Receivable, etc. as per list 'E'
Good... 10,598.70 Doubtful... NIL Bad... NIL
Estimated to produce ... 5,000.00 4. Bills of exchange, promissory notes, etc. as
per list'P... NIL 5. Deposits in Financial Institutions... 200.00 6. Cash ... NIL 7. Livestock... NIL 8. Machinery, equipment and plant... NIL 9. Real property or immovable as per list 'G'... NIL 10. Furniture... 1.00 11. RRSPs, RRIFs, Life Insurance, etc ... NIL 12. Securities (Shares, bonds, debentures, etc)... NIL 13. Interest under wills ... NIL 14. Vehicles... NIL 15. Other Property ... NIL
If Bankrupt is a Corporation add: Amount of capital subscribed Amount paid thereon
Balance subscribed and unpaid Estimated to produce Total Assets... Deficiency... NIL NIL NIL NIL 10,201.00 199,404.25 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
CENTURY HOME OXYGEN & CPAP INC.
OF THE TOWN OF RICHMOND HILL, IN THE PROVINCE OF ONTARIO List 'A'
Unsecured Creditors
No Name Address Account No. Amount of claim
1 American Express
2 Business Development Bank of Canada
3 Canada Revenue Agency - London TSO
4 Douglas Stanmore
5 Leonard and Elizabeth Stanmore
Linde
ScotiaLine visa
c/o Total Credit Recovery Limited 225 Yorkland Blvd.
Toronto ON M2J 4Y7 150 King Street West Suite 100
Toronto ON M5H 1J9 Revenue Collections Division Regional Intake Centre for Insolvency 451 Talbot Street, 3rd Floor
London ON N6A 4R3 Allan Lipman
Lipman Zener & Waxman LLP 1220 Eglinton Avenue West Toronto ON M6C 2E3 Allan Lipman
Lipman Zener & Waxman LLP 1220 Eglinton Avenue West Toronto ON M6C 2E3
Linde Central Customer Service Centre 5860 Chedworth Way
Mississauga ON L5R OA2 284 Queen Street East Brampton ON L6V 1C2 4538280254306013 12,922.89 95,399.00 Unknown 80,000.00 58,000 1,166.40 9,915.96 257,404.25 Dated: April 16, 2009 Signature of Bankrupt or (
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
"TOTAL* 105,600.00 105,600.00 10,201.00 0.00 95,399.00 95,399.00 ated: April 16, 2009
CENTURY HOME OXYGEN & CPAP INC.
OF THE TOWN OF RICHMOND HILL, IN THE PROVINCE OF ONTARIO 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 •TOTAL* / Unknown C"^. 0.00 Unknown April 16,2009
OF THE TOWN OF RICHMOND HILL, IN THE PROVINCE OF ONTARIO 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 Dated: April 16, 2009 ') <———————— *TOTAL* $0.00 ---/ ^^"^-^ ^=,^- ^^^^-~—-=======-——.„., ... )
CENTURY HOME OXYGEN & CPAP INC.
OF THE TOWN OF RICHMOND HILL, IN THE PROVINCE OF ONTARIO 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
Account Receivable *TOTAL* 10,598.70 0.00 0.00 Contracted Yr Mo Estimated to Produce 5,000.00 5,000,00 April 16, 2009
OF THE TOWN OF RICHMOND HILL, IN THE PROVINCE OF ONTARIO 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
CENTURY HOME OXYGEN & CPAP INC.
OF THE TOWN OF RICHMOND HILL, IN THE PROVINCE OF ONTARIO List 'G'
Real Property or Immovable Owned by
Description of Property Total Nature of's Interest Value In Whose Name Does Tide Stand
*TOTAL* 0.00
Equity Particular of Mortgages, Hypothecs or other Encumbrances
Name & Address Amount 0.00
--»
id: April 16, 2009
OF THE TOWN OF RICHMOND HILL, IN THE PROVINCE OF ONTARIO 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
(h) Life insurance policies, RRSPs, etc. (i) Securities
(j) Interests under wills, etc. (k) Vehicles
(1) Taxes
(m) Other property
Inventory (encumb.)
Cash in Bank (encumb.)
Office Furniture and Equipment (encumb.)
72,800.00 200.00 18,500.00 *TOTAL* 5,000.00 NIL 200.00 NIL NIL NIL 1.00 NIL NIL NIL NIL NIL NIL 5,201.00 Dated: April 16, 2009
Bankruptcy No.
IN THE MATTER OF THE BANKRUPTCY OF
CENTURY HOME OXYGEN & CPAP INC.
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)645-6500
