Name:
NET INCOME
WAGES, SALARIES, AND OTHER INCOME SOURCES:
____________YOURS
____________SPOUSE'S
____________UNEMPLOYMENT
____________FINANCIAL AID
____________INCOME PROPERTY
____________DIVIDENDS
____________INTEREST
____________SAVINGS
____________401 K
____________LIFE INSURANCE (CASH VALUE)
____________PELL GRANT
____________OTHER____________________
____________OTHER____________________
____________TOTAL INCOME
EXPENSES
HOUSING:
____________RENT
____________MORTGAGE PAYMENTS (FIXED)
____________SECOND MORTGAGE
____________MAINTENANCE FEES (CONDO OR COOPERATIVE)
____________MAINTENANCE AND FURNISHING
____________HOUSING EXPENSES
TRANSPORTATION:
____________AUTOMOBILE LOAN PAYEMENTS (FIXED)
____________GAS, OIL, OTHER MAINTENACE AND REPAIRS
____________LICENSES, PARKING, AND OTHER AUTO
____________OTHER
____________TRANSPORTATION EXPENSES
FOOD AND OTHER CONSUMPTION ITEMS:
____________FOOD AND HOUSEHOLD SUPPLIES
____________MEALS EATEN OUT
____________PERSONAL CARE
____________OTHER
____________FOOD AND CONSUMPTION EXPENSES
UTILITIES:
____________TELEPHONE
____________GAS AND ELECTRIC
____________WATER AND SANITATION
____________GARBAGE PICKUP
____________CABLE TV
____________OTHER
____________UTILITIES EXPENSE
TAXES:
____________REAL ESTATE
____________PERSONAL
____________TAX TOTALS
INSURANCE:
____________HEALTH AND MEDICAL WITHHELD FROM WAGES
____________LIFE
____________PROPERTY AND LIABILITY
____________AUTOMOBILE
____________DISABILITY
____________OTHER
____________INSURANCE TOTALS
CREDIT CARD PAYMENTS:
____________VISA
____________MASTERCARD
____________DISCOVER
____________GAS CREDIT CARDS
____________OTHER___________________
____________OTHER___________________
____________TOTAL CREDIT CARD PAYMENTS
CHILD CARE:
____________CHILD CARE EXPENSE
____________TOTAL CHILD CARE EXPENSE
LEISURE AND ENTERTAINMENT:
____________THEATER AND SPORTING EVENTS
____________HEALTH CLUB MEMBERSHIPS
____________NEWSPAPERS, MAGAZINES, ETC.
____________VACATIONS
____________HOBBIES
____________SPORTING EQUIPMENT
____________OTHER____________________
____________OTHER____________________
____________TOTAL LEISURE AND ENTERTAINMENT
CLOTHING:
____________NEW CLOTHING
____________LAUNDRY AND DRY CLEANING
____________OTHER____________________
____________CLOTHING EXPENSE
OTHERS:
____________GIFTS AND CHARITABLE CONTRIBUTIONS
____________DUES
____________MEDICAL
____________DENTAL
____________EDUCATIONAL
____________PERSONAL ALLOWANCES
____________LOANS____________________
____________LOANS____________________
____________TOTAL EXPENSES
SAVINGS:
____________SAVINGS ACCOUNT
____________RETIREMENT
____________TOTAL SAVINGS
____________TOTAL EXPENSES