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RENT OR MORTGAGE PAYMENT Does mortgage include taxes? YES or NO ( circle one ) Does mortgage include insurance? YES or NO ( circle one ) |
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| Electricity & gas used for heating & cooking | |
| Water | |
| Phone ( including cellular) | |
| Cable T.V. | |
| Garbage Collection | |
| Food | |
| Clothing | |
| Laundry & cleaning supplies | |
| Dental, medical visits & prescription drugs | |
| Gasoline & car maintenance | |
| Recreation, clubs & entertainment (including news papers & magazines) | |
| Home owners or renters insurance | |
| Life insurance ( not already deducted from paycheck) | |
| Health insurance Life insurance ( not already deducted from paycheck) | |
| Car/truck insurance | |
| Taxes (real estate & personal property~NOT income tax) | |
| Installment payments (car, furniture, or other secured debts) | |
| Installment payments (car, furniture, or other secured debts) | |
| Installment payments (car, furniture, or other secured debts) | |
| Day care or child care expenses | |
| Court ordered child support or alimony payments | |
| Other regular monthly living expenses such as student loans, court fines. etc. | |
| TOTAL |