Form 11-13B

(Subrule 11-13(2))

COURT FILE NUMBER / ______
COURT OF QUEEN’S BENCH FOR SASKATCHEWAN
JUDICIAL CENTRE / ______
PLAINTIFF(S)/
APPLICANTS / ______
DEFENDANT(S)/ RESPONDENTS / ______

BILL OF COSTS

[NAME AND STATUS]

Fees claimed:

ITEM NO. / ITEM / AMOUNT

Disbursements:

DESCRIPTION / AMOUNT

Other Charges:

DESCRIPTION / AMOUNT

GST:

(a) Amount claimed on fees: $ ______

(b) Amount claimed on disbursements: $ ______

(c) Amount claimed on other charges: $ ______

TOTAL GST:$ ______

PST:

(a) Amount claimed on fees: $ ______

(b) Amount claimed on disbursements: $ ______

(c) Amount claimed on other charges:$ ______

TOTAL PST:$ ______

Total amount claimed:

Fees: $ ______

Disbursements: $ ______

Other Charges: $ ______

GST: $ ______

PST: $ ______

TOTAL: $ ______

Amount allowed by assessment officer:

Fees: $ ______

Disbursements: $ ______

Other Charges: $ ______

GST: $ ______

PST:$ ______

TOTAL: $ ______

Person responsible for preparation of this Bill of Costs:

______

(signature)

______

(print name)

CERTIFICATE OF ASSESSMENT OFFICER:

I, ______, certify the following amount(s) that is (are) to be paid

By plaintiff: $ ______

By defendant: $ ______

to ______.

(name of party or parties to receive the costs awarded)

I also certify the following special circumstance(s) and the amount to be paid by each party with respect to the special circumstance(s):

______

(date)

______

Assessment Officer

A certificate in the form of an affidavit is required if the goods and services tax or if provincial sales tax is claimed as part of the Bill of Costs.

AFFIDAVIT of ______

SWORN (OR AFFIRMED) on ______, 2______

I, ______, whose address is ______,

have personal knowledge of the following:

1 The party entitled to receive payment under the Bill of Costs attached to (or endorsed on or filed with) this Bill of Costs, and not another party, will actually be paying the goods and services tax or provincial sales tax on that party’s costs.

2 The goods and services tax and provincial sales tax will not be passed on to, or be reimbursed by, any other person.

3 The party entitled to receive payment under the Bill of Costs is not eligible for the goods and services tax input tax credit or a personal sales tax credit.

SWORN (OR AFFIRMED) BEFORE ME / / ______
(signature)
______
(print name)
at, ______, Saskatchewan,
this ______day of ______,
2______.
______
Commissioner for Oaths
for Saskatchewan