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Put in the amount of your gross earnings from your paycheck(s), and other income, such as pension income, investment income, alimony & child support received, as well as gifts.

Salary and wages

Total from all sources

Bonuses, commissions, tips

Total from all sources

Self-employment income

Total from all sources

Interest and dividends

Include this only if the total is more than $200

Alimony/child support received

Total amount

Gifts received

Total amount

Pension income

Total amount

Social Security income

Total amount

Public assistance, unemployment and/or disability benefits

Total amount

Other income: _______________

All other income

TOTAL INCOME

Total the income amounts above.

Savings/investing

Whatever amount you are saving and investing. Include the amount you put into your 401(k), IRAs, and other retirement accounts.

Federal & state taxes

Enter the amount for federal and state taxes. Include Social Security, Medicare, and local tax. Use your pay stub, or use the amount from your last year's tax return if you're using Statement II and you don't expect many changes in your taxable income. Note: Due to your decrease in income, you may be able to subtract a little.

Mortgage or rent

What you pay, not including taxes and insurance. If your mortgage payment includes taxes and insurance, leave those lines blank below.

Home repair/maintenance

Any maintenance and repairs on your home or apartment, condo fees, etc.

Property taxes

Real estate (and in some states) personal property taxes

Disability Insurance

Include any insurance premiums deducted from your paycheck

Life insurance

Include any insurance premiums deducted from your paycheck

Home/renter's insurance

Premium payments

Auto insurance

Premium payments

Credit card/loan payment

Loans other than your mortgage, including car loans and credit card payments

Utilities & telephone

Water, telephone, electricity, gas, garbage, sewer, etc.

Food (include dining out)

All food and restaurants

Clothing

All clothes

Grooming

Hair care, beauty supplies, etc.

Transportation

Gas for automobiles and other modes of transportation

Auto repair/maintenance

Major repairs, oil changes, new tires, etc.

Other transportation

Tolls, train fare, bus fare, etc.

Medical care

Medical and Dental expenses not covered by insurance, including health insurance premiums deducted from your paycheck and all other health insurance premiums.

Education

Tuition and fees, room and board, meal plans, etc.

Child care

All costs for babysitting and child care expenses

Alimony/child support

Amounts paid

Entertainment

Sporting events, hobbies, movies, etc.

Vacations

Including airplane fare

Gifts/charitable contributions

Gifts to charitable organizations, gifts to relatives and friends

Laundry/cleaning

Amount spent

Other: _____________________

All other items of outflow unique to your situation.

TOTAL OUTFLOW

Total the outflow amounts above.

NET CASH FLOW

Subtract outflow from income