Monthly Cash Flow Statement


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Last Name -
Monthly Cash Inflows
Your Salary/Wages (List both monthly gross earnings and take-home pay after payroll deductions.)
Your Cash Advances (List all payroll advances or other advances from work.)
Your Cash Bonuses (List all payments from work in addition to your salary that are not an advance.)
Commissions (List all non-employee earnings as an independent contractor.)
Business Income (List both monthly gross income and net income after deducting expenses.)
Interest (List all interest earned each month.)
Dividends (List all dividends earned each month.)
Rental Income (List all monthly income received from real estate properties owned.)
Trust Income (List all trust income earned each month.)
Alimony/Child Support (List all alimony or child support payments received each month.)
Social Security (List all payments received from Social Security.)
Other Government Benefits (List all amounts received from the government not yet reported
(e.g., Aid to Families with Dependent Children.)
Pensions/Annuities (List all funds received from pensions and annuities each month.)
Allowances-Housing/Auto/Travel (List all funds received from housing allowances, auto allowances,
travel allowances, and any other kind of allowance.)
Gratuities/Tips (List all gratuities and tips received each month from any and all sources.)
Spouse/Significant Other Salary/Wages (List all gross and net monthly salary and wages received by
your spouse or significant other.)
Other Joint Spousal Income (List any monthly income jointly earned with your spouse or significant
other [e.g., any income from spouse or income from a business owned or operated by the spouse that
you have a joint ownership interest in or control]).
Income of Other In-House (List all monthly income of others living in the household or the
monthly amount actually paid for household bills by these persons.)
Gifts from Family (List all amounts received as gifts from family members each month.)
Gifts from Others (List all gifts received from any sources not yet reported.)
Loans from Your Business (List all loan amounts received each month from all businesses owned
or controlled by you.)
Mortgage Loans (List all amounts received each month from mortgage loans owed to you.)
Other Loans (List all other loan amounts received each month not yet reported.)
Other (specify) (List all other amounts received each month not yet reported.)


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