| Estimated Income | Yearly Amount | Monthly Amount | Estimated Expenses | Yearly Amount | Monthly Amount |
| Salary And Adjustments | Housing | ||||
| Net Salary | Rent/Mortgage | ||||
| (Gross Salary less F.I.C.A./Medicare, | |||||
| Federal tax, and state and local tax) | Utilities | ||||
| Gas and Electricity | |||||
| Telephone | |||||
| Non-Taxable Income | Water | ||||
| AFDC | |||||
| Veterans Benefits | Transportation | ||||
| Social Security | Bus/Train | ||||
| Other | Gas/Maintenance | ||||
| Parking | |||||
| Other Income | |||||
| Interest Income | Food and Personal | ||||
| Investment Income | Groceries | ||||
| Clothing | |||||
| Dining Out | |||||
| Laundry/Dry Cleaning | |||||
| Entertainment | |||||
| Other | |||||
| Debt Obligations | |||||
| Student Loans | |||||
| Car Payment | |||||
| Credit Cards | |||||
| Other Loans | |||||
| Insurance | |||||
| Car | |||||
| Rent/Home | |||||
| Health | |||||
| Life | |||||
| Health Care | |||||
| Deductible/Copayments | |||||
| Doctor/Dentist Visits | |||||
| Prescriptions | |||||
| Savings | |||||
| Miscellaneous | |||||
| TOTAL INCOME | TOTAL EXPENSES | ||||
| YOUR BALANCE= ______________Yearly _____________Monthly | |||||