Grant Thornton Monthly Statement Of Income And Expenses

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Monthly Statement of Income and Expenses
/
Month of:
Office / Month of bky
Name: ___________________________________
Phone Number: (H) ____________ (W) ____________ (C) ____________
Address: _____________________________________________________________________________________________________
# of persons in household family unit, including bankrupt: ________
Has your address recently changed? Yes ______ No ______
Income
(Attach pay stubs/verification)
Monthly
Non-Discretionary Expenses (Attach receipts)
Monthly
Net employment income
Child support payments
Net employment income of spouse
Spousal support payments
Net pensions/annuities
Child care
Net child/spousal support
Medical expenses
Net child tax/universal child care benefits
Fines/penalties existing at date of bankruptcy
Net EI benefits/social assistance
Interest on student loans
Net self-employment income
Other income – describe
Total monthly income
(A)
Total monthly non-discretionary expenses
(B)
Discretionary Expenses (Do not send receipts)
Monthly
Monthly
Housing Expenses
Living Expenses
Rent/Mortgage(s)
Food/Grocery
Property taxes/Condo fees
Laundry/Dry Cleaning
Heating/Gas/Oil
Grooming/Toiletries
Telephone/Cell/Internet
Clothing
Cable/Internet
Bank Charges/Newspaper
Hydro
Other –
Water
Transportation Expenses
Home Maintenance
Car Lease/Payments
Other –
Repair/Maintenance/Gas
Personal Expenses
Public Transportation
Smoking
Other –
Insurance Expenses
Alcohol
Dining/Lunches/Restaurants
Vehicle
Entertainment/Sports
House
Gifts/Charitable Donations
Furniture/Contents
Allowances
Life Insurance
Education
Other –
Other –
Payments
To the Trustee
To secured creditor
Other –
Total Monthly Discretionary Expenses
(C)
Superintendent Standard Calculation
(Family of _______/ Standard $ ________)
Total Income
$ ________________
((A)
from above)
Minus: Superintendent Standard (SS) for ___ persons
$ -________________
NOTE:
The greater of
Non-discretionary Expenses (receipts must be attached)
$ -________________
((B)
from above)
(H)
or your bankruptcy
fee must be sent to the
Income after SS Deduction
(G) $ ________________
th
Trustee by the 10
day
of each month.
Surplus payment
– 50% of the amount in line (G)
(H)
$ ________________
Failure to do so, may
delay your Automatic
discharge.
R:\MARKETING\AB Files\Letters\NameChange\Monthly Statement.doc
Jan 11

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