Form 106j - Schedule J: Your Expenses Page 2
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1
2
3Debtor 1
_______________________________________________________
Case number
_____________________________________
(if known)
First Name
Middle Name
Last Name
Your expenses
$_____________________
Additional mortgage payments for your residence, such as home equity loans
5.
5.
Utilities:
6.
Electricity, heat, natural gas
$_____________________
6a.
6a.
Water, sewer, garbage collection
$_____________________
6b.
6b.
Telephone, cell phone, Internet, satellite, and cable services
$_____________________
6c.
6c.
Other. Specify: _______________________________________________
$_____________________
6d.
6d.
Food and housekeeping supplies
$_____________________
7.
7.
Childcare and children’s education costs
$_____________________
8.
8.
Clothing, laundry, and dry cleaning
$_____________________
9.
9.
Personal care products and services
$_____________________
10.
10.
Medical and dental expenses
$_____________________
11.
11.
Transportation. Include gas, maintenance, bus or train fare.
12.
$_____________________
Do not include car payments.
12.
Entertainment, clubs, recreation, newspapers, magazines, and books
$_____________________
13.
13.
Charitable contributions and religious donations
$_____________________
14.
14.
1
Insurance.
15.
Do not include insurance deducted from your pay or included in lines 4 or 20.
Life insurance
$_____________________
15a.
15a.
Health insurance
$_____________________
15b.
15b.
Vehicle insurance
$_____________________
15c.
15c.
Other insurance. Specify:_______________________________________
$_____________________
15d.
15d.
Taxes. Do not include taxes deducted from your pay or included in lines 4 or 20.
16.
$_____________________
Specify: ________________________________________________________
16.
Installment or lease payments:
17.
$_____________________
Car payments for Vehicle 1
17a.
17a.
$_____________________
Car payments for Vehicle 2
17b.
17b.
$_____________________
Other. Specify:_______________________________________________
17c.
17c.
$_____________________
Other. Specify:_______________________________________________
17d.
17d.
Your payments of alimony, maintenance, and support that you did not report as deducted from
18.
your pay on line 5, Schedule I, Your Income (Official Form 106I).
18.
$_____________________
Other payments you make to support others who do not live with you.
19.
Specify:_______________________________________________________
$_____________________
19.
Other real property expenses not included in lines 4 or 5 of this form or on Schedule I: Your Income.
20.
$_____________________
Mortgages on other property
20a.
20a.
$_____________________
Real estate taxes
20b.
20b.
$_____________________
Property, homeowner’s, or renter’s insurance
20c.
20c.
$_____________________
Maintenance, repair, and upkeep expenses
20d.
20d.
$_____________________
Homeowner’s association or condominium dues
20e.
20e.
Official Form 106J
Schedule J: Your Expenses
page 2
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