Monthly Cash Flow Statement (Page 2 of 2) in pdf

Monthly Cash Flow Statement Page 2

PROB 48B

Page 3 of

(9/00)

Last Name -

Necessary Monthly Cash Outflows

Amount

Rent or Mortgage (List monthly rental payment or mortgage payment.)

Groceries (List the total monthly amount paid for groceries and number of people in your household.)

Utilities (List the monthly amount paid for electric, heating oil/gas, water/sewer, telephone, and basic cable.)

Electric

Heating Oil/Gas

Water/Sewer

Telephone

Basic Cable (no premium channels)

Transportation (List monthly amount paid for gasoline, motor oil, necessary auto repairs, or the cost of public transportation.)

Insurance (List the monthly amount paid for auto, health, homeowner/rental, and life insurance.)

Auto

Health

Homeowner/Rental

Life

Clothing (List the monthly amount actually paid for clothing.)

Loan Payments (List all monthly amounts paid toward verified loans, other than loans to family members, which are

non-allowable expenses.)

Credit Card Payments (List all monthly credit card or charge card payments.)

Medical (List all monthly payments for necessary medical care or treatment.)

Alimony/Child Support (List all alimony or child support payments made each month.)

Co-payments (List the total monthly payments made for electronic monitoring and drug and mental health treatment.)

Other (specify) (List all other necessary monthly amounts paid each month not yet reported.)

Monthly Criminal Monetary Penalty Payment:

Other Factors That May Affect Monthly Cash Flow (Describe)

TOTAL

NET MONTHLY CASH FLOW: $

(CASH INFLOWS LESS NECESSARY CASH OUTFLOWS)

PROSPECT OF INCREASE IN CASH INFLOWS (Give a general statement of the prospective increase of the value of any cash inflows reported.)

Signature

Date

Monthly Cash Flow Statement Page 2