Form 1 (Through 6) - Transmittal Of Financial Reports And Certification Of Compliance With United States Trustee Operating Requirements Page 2

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INCOME/EXPENSE STATEMENT FOR INDIVIDUALS (P&L)
Period Ending:
Case No:
Current Month
Total
Since Filing
Gross Income from Salary/Wages
Less Payroll Deductions:
a. Payroll Taxes & Social Security
b. Insurance Deducted
c. Other (specify)
d. Other (specify)
Subtotal of Payroll Deductions
Total Net Take Home Pay
Other Than Salary
Gross receipts from business
Interest & Dividends
Alimony, Maintenance or Support Payments
Social Security or other Government Assistance
Pension or Retirement Income
Other Income (specify)
Total Monthly Income
Rent or Home Mortgage Payment
Food
Clothing
Laundry & Dry cleaning
Medical & Dental Expenses
Personal Grooming
Car payment - Motorhome
Car payment - Honda
Transportation (gasoline)
Vehicle repairs and maintenance
Recreation, Entertainment, Publications, etc
Charitable Contributions
Insurance:
Homeowner's
Life
Auto
Other
Utilities
Taxes ( not deducted from wages)
Alimony, Maintenance or Support Payments
Business Expenses
Form 2

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