Rent/home mortgage payment

$__________

Electricity & Natural Gas

$__________

Water and Sewer

$__________

Telephone

$__________

Cable/Satellite Television

$__________

Other

$__________

Home maintenance (repairs and upkeep)

$__________

Food

$__________

Clothing

$__________

Laundry and dry cleaning

$__________

Medical and dental expenses

$__________

Transportation (include gasoline, maintenance,

 and repairs; do not include car payments)

$__________

Recreation, books, newspapers, magazines, etc.

$__________

Charitable contributions

$__________

Homeowner's /renter's insurance (if not included in housing payment)

$__________

Life Insurance (if not deducted from payroll)

$__________

Health insurance (if not deducted from payroll)

$__________

Auto Insurance   

$__________

Other insurance _____________________________

$__________

Taxes (not deducted from wages or included in housing payments)

$__________

Auto Payment 1 (vehicle) ___________________________

$__________

Auto Payment 2 (vehicle) ___________________________

$__________

Other Installment Payment ___________________________

$__________

Alimony, maintenance and/or support paid

$__________

Support payments for additional dependents not at your home

$__________

Regular expenses from operation of business, profession, or farm

$__________

Total Monthly Expenses

$__________