| INCOME |
|
|
|
| |
Take Home Pay (all family members) |
___________ |
|
| |
Child Support/Alimony |
___________ |
|
| |
Pension/Social Security |
___________ |
|
| |
Disability/Other Insurance |
___________ |
|
| |
Interest/Dividends |
___________ |
|
| |
Other |
___________ |
|
| |
Total Income |
|
___________ |
| |
|
|
|
| EXPENSES |
|
|
|
| |
Rent/Mortgage (include taxes, principal, and insurance) |
___________ |
|
| |
Life Insurance |
___________ |
|
| |
Health/Disability Insurance |
___________ |
|
| |
Vehicle Insurance |
___________ |
|
| |
Homeowner’s or Other Insurance |
___________ |
|
| |
Car Payments |
___________ |
|
| |
Other Loan Payments |
___________ |
|
| |
Savings/Pension Contribution |
___________ |
|
| |
Utilities (gas, water, electric, phone) |
___________ |
|
| |
Credit Card Payments |
___________ |
|
| |
Car Upkeep (gas, maintenance, etc.) |
___________ |
|
| |
Clothing |
___________ |
|
| |
Personal Care Products (shampoo, cologne, etc.) |
___________ |
|
| |
Groceries |
___________ |
|
| |
Food Outside the Home (restaurant meals and carryout) |
___________ |
|
| |
Medical/Dental/Prescriptions |
___________ |
|
| |
Household Goods (hardware, lawn, and garden) |
___________ |
|
| |
Recreation/Entertainment |
___________ |
|
| |
Child Care |
___________ |
|
| |
Education (continuing education, classes, etc.) |
___________ |
|
| |
Charitable Donations |
___________ |
|
| |
Miscellaneous |
___________ |
|
| |
Total Expenses |
|
___________ |
| |
|
|
|
| |
Remaining Income After Expenses
(Subtract Total Income from Total Expenses) |
|
___________ |
