Base Pay: Federal Tax: ___________________
BAQ: _______________________________ FICA: ______________________________
BAS: ________________________________ Medicare: ___________________________
BAH: ________________________________ SGLI: ______________________________
COLA: _______________________________ Debt to Gvt.: ________________________
Clothing Allow: _________________________ Other: _____________________________
Spouse Income: _________________________ Other: _____________________________
Other Income: ___________________________ Other: ____________________________
GROSS INCOME: ______________________ TOTAL COLLECTIONS: _____________
3. NET INCOME: 4. EXPENSES: (See Section 6)
Gross Income: ________________________ Monthly Living Expenses: ________________
Total Collections: ______________________ Annual Expenses by Month: ______________
Other Deductions: ______________________ Installment Debt: ______________________
NET INCOME: ________________________ Total Monthly Expenses: ________________
5. MONTHLY BALANCE SHEET:
Net Income (Section 3)____________________________________________________
Monthly Expenses (Section 4)_______________________________________________
Remainder (Plus or Minus)__________________________________________________
6. MONTHLY LIVING EXPENSES:
Housing Rent/Mortgage (incl. Taxes/insurance) _________________
Utilities (Elec./Gas/Water/Sewer) _______________________
Telephone _____________________
Cable TV ________________
Food/Household Supplies _____________________
Food/other (i.e., lunches/dinners out) __________________
Car Gas/Oil
Car Payments ___________________
Other (Maintenance, etc.) ______________________
Personal Hair Care (Barber/ Beauty shop) ________________________
Toiletries __________________
Cigarettes/Tobacco _____________________
Clothing Family _____________________
Laundry/Dry Cleaning _____________________
Other Books/Newspapers/Magazines _____________________
Donations _____________________
Life Insurance _____________________
Club/Recreational Activities _____________________
Baby Sitters _____________________
Child Support/Alimony _____________________
Other _____________________
Annual Auto Insurance (Divide by 12) _____________________
License Plates (Divide by 12) _____________________
Other (Divide by 12) _____________________
TOTAL MONTHLY EXPENSES _______________________
