Form Cfs - Comprehensive Financial Statement Page 5

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EFO00122
Financial Statement Page 5
08-23-10
SECTION 5. MONTHLY INCOME AND EXPENSE ANALYSIS
Income.
Attach copies of all income sources that contribute to household expenses.
Gross
Net
28. Wages / Salaries / Tips (yours)
29. Pension (yours)
30. Overtime / Bonuses / Commissions (yours)
31. Wages / Salaries / Tips (spouse’s)
32. Pension (spouse’s)
33. Overtime / Bonuses / Commissions (spouse’s)
34. Business income (yours)
35. Business income (spouse’s)
36. Rental income
37. Interest / Dividends / Royalties (average monthly)
38. Payments from trust / Partnerships / Entities
39. Child support
40. Alimony
41. Unemployment
42. Disability
43. Seller carried contracts / Sales
44. Other income: specify
45. Other income: specify
46. TOTAL INCOME:……………………………………………………………………………………………………………………… ...
$
Personal expenses
(actually paid).
Monthly Amount
□
□
47.
Rent
Own
If renting – name, address, and telephone number of landlord
□
□
48. Real estate taxes (Is this included in your mortgage payment?)
Yes
No
49. Homeowners / Renters insurance: (
) Association fees: (
)
50. Utilities: Electric ($
) Heating gas / Oil ($
) Cable ($
)
Cell phone ($
) Phone ($
) Water / Garbage / Sewer ($
)
51. Groceries/Food
52. Gifts & entertainment
53. Clothing
54. Auto payments / Lease
55. Auto insurance

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