Worksheet

Monthly Expenses

Rent: $______

Mortgage Payment (principal and interest): $______

Home Owners Insurance: $______

Real Estate Property Taxes: $______

Home Maintenance: $______

Heating Costs: $______

Water and Sewer: $______

Electric Bill: $______

Gas Bill: $______

Telephone Bill: $______

Groceries: $______

Eating Out: $______

Entertainment: $______

Education Expenses (including tuition, books and supplies): $______

Childcare/Daycare: $______

Automobile Payments (leased or financed): $______

Auto Insurance: $______

Automobile Maintenance: $______

Gasoline: $______

Public Transportation/Tolls: $______

Federal Taxes: $______

State Taxes: $______

City Taxes: $______

Laundry/Dry Cleaning: $______

Clothing/Accessories (including uniforms/supplies): $______

Medical and Dental Bills: $______

Medical/Dental Insurance (including co-payments): $______

Prescription and Non-Prescription Medication: $______

Alimony (paid): $______

Child Support (paid): $______

Life Insurance: $______

Cable/Satellite: $______

Cellular Phone: $______

Additional Monthly Expenses (state expense and how much is paid): $______

Total Monthly Expenses: $______

Monthly Income

Total Monthly Income (yearly income ÷ 12): $______

Bonuses: $______

Dividends/Interest Income: $______

Retirement Income: $______

Alimony (received): $______

Child Support (received): $______

Public Assistance Income: $______

Additional Income (state source and how much): $______

Total Monthly Income: $______

Personal Assets

Checking Account Balance: $______

Savings Account/Miscellaneous Savings Balance: $______

Pension/Retirement Fund Account Balance: $______

Total Personal Assets: $______