Monthly Take-Home Income Salary/Wages Salary/Wages (Spouse) Social Security Military Pay Pension Plan/Retirement Interest Income Alimony/Child Support Real Estate (Rent) Dividends (Investments) Unemployment/Food Stamps Royalties/Other Income Total Income Monthly Living Expenses Food (Home, Work, School) Household Items Clothing Laundry/Dry Cleaning Telephone (Home, Cell, Pager) Internet Service Cable TV/Satellite Electric Gas/Oil Water/In-Home Service Trash Service Auto Gas/Maintenence Auto Insurance Health Dental Insurance Life Disability Insurance Homeowners/Renters Insurance Education (Tuition, Supplies) Personal Care (Hair, Nails, etc) Medical Care (Prescriptions, etc.) Child Care (Nanny, Day Care) Children Activities (Sports, etc.) Alimony/Child Support Gardener/Pool/Alarm Service Entertainment Homeowner Dues Subscriptions Health Club Membership Contributions/Donations/Gifts Other Expenses (Misc.) Total Expenses Monthly Secured Debts Rent (Apartment, etc) 1st Mortgage/Taxes/Insurance 2nd Mortgage/Taxes/Insurance Trailer Park Space Rent Student Loans Auto Loans/Leases Recreation Toys (Watercraft, etc.) Past-Due Taxes Other Secured Debts Other Secured Loans Total Secured Debt Monthly Unsecured Debts Credit Card Credit Card Credit Card Credit Card Credit Card Credit Card Personal Loan Personal Loan Medical/Dental Bills Other Unsecured Loans Total Unsecured Debt
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