Personal Financial Statement

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PERSONAL FINANCIAL STATEMENT
Name/Grade/Rank:
Date:
Marital Status:
# of Dependents:
Ages:
I. MONTHLY INCOME
Gross Salary (Base Pay/BAQ.VHA/Rations)
$
Minus Your Total Deductions/Allotments
$
(Medical insurance, automatic payments, loans, etc.)
=
$
YOUR TOTAL NET SALARY
Your Total Net Salary
$
Your Spouse’s Net Salary
+
$
+
Additional Income
$
(Part-time employment or child support, alimony, etc.)
=
YOUR TOTAL (COMBINED) NET INCOME
$
II.
:
MONTHLY EXPENSES
Ensure your figures are as accurate as possible.
Rent/Mortgage (home owner/condo fees)
$
Child Care/Child Support/Alimony
$
(if not automatically deducted)
Cable TV
$
(movie channels, HBO, DDS, etc.)
{The following Expenses should be averaged per month}
Utilities
$
(water, electric, gas)
Telephone
$
(Bell Atlantic + long distance service)
Groceries
$
Restaurant Expenses
$
(dinner/take out)
Lunch Expenses
$
(office luncheons, school lunches)
Medical Expenses
$
(over the counter/prescription)
Life Insurance
$
(if not automatically deducted)
Car Insurance
$
(if not automatically deducted)
Car Expenses
$
(gas, maintenance, tires, etc)
Property Tax/Real Estate Tax
$
(if applicable)
Clothing
$
(entire family)
Education
$
(tuition, books, supplies)
Entertainment
(movies/videos, babysitter, allowance, Internet,
Magazines/books, newspapers, functions, travel, etc.)
$
b-days, anniversary, mother/father’s day, valentines’ day, etc.)
Misc. Gifts
$
Christmas Gifts
(spouse, children, in-laws, siblings, friends, co-workers)
Miscellaneous
$
(dry cleaners, barber/salon, pagers, cell phones,
Church tithings, charities, toiletries, home furnishings & accessories, etc.)
=
$
YOUR TOTAL MONTHLY EXPENSES
1

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