Rent
or home mortgage payment
(include lot rented for mobile home) $______________ |
Are
real estate taxes include? Yes_____No_____
If no, how much $_______________ |
Is
property insurance included? Yes_____No_____
In no, how much $_______________ |
| Utilities
(Electricity and Gas) $_______________ |
| Water
and Sewer $_______________ |
| Telephone
$_______________ |
| Cable
$_______________ |
| Pest
Control $_______________ |
| Security
$_______________ |
| Other
$_______________ |
| Home
Maintenance (Repairs and Upkeep) $_______________ |
| Food
$_______________ |
| Lunches
(eating out) $_______________ |
| Clothing
$_______________ |
| Laundry
and dry cleaning $_______________ |
Medical
and dental expenses
(Doctor visits, prescriptions, etc.) $_______________ |
Auto
Expense (gas, oil changes, repairs.)
(Don't include care payments) $_______________ |
Recreation,
clubs, and entertainment,
newspapers, magazines, etc. $_______________ |
| Charitable
contributions $_______________ |
Insurance
(not deducted from wages or
included in home mortgage payment)$_____________ |
| Homeowner's
or renter's $_______________ |
| Life
$_______________ |
| Heatlh
$_______________ |
| Auto
$_______________ |
| Other
$_______________ |
| Personal
items (toiletries, etc) $_______________ |
Alimony,
maintenance, and support of additional dependents
not living at your home $________ |
Payments
for support of additional dependents not
living at your home $_______________ |
Regular
expenses from operation of business, profession,
or farm (attach detailed statement) $_______________ |
| School
Expenses $_______________ |
