Debt Relief Worksheet Page 9
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10Debt Relief Worksheet
Page 9
Monthly Income and Expense Statement of the Bankrupt and the Family Unit
(YOUR BUDGET MUST BALANCE, I.E. YOUR EXPENSES CAN NOT EXCEED YOUR INCOME)
MONTHLY INCOME - # of People in Family : _______
BANKRUPT
SPOUSE
TOTAL
(PLEASE PROVIDE SUPPORTING DOCUMENTATION)
Net Employment Income (Take Home) .............................
Pension/Annuities .............................................................
Child Support.....................................................................
Spousal Support ................................................................
Child Tax Benefit ...............................................................
Employment Insurance Benefits .......................................
Social Assistance ..............................................................
Self-Employment Income: Gross ______________
Net
Other Net Income (Provide details):
NET MONTHLY INCOME .................................................
(1)
(2)
NET MONTHLY INCOME OF THE
FAMILY UNIT((1)+(2)) .......................................................
(3)
MONTHLY NON-DISCRETIONARY EXPENSES
(PLEASE PROVIDE SUPPORTING DOCUMENTATION)
Child Support Payments/Alimony......................................
Child Care .........................................................................
Prescriptions......................................................................
Fines/Penalties Imposed by the Court ..............................
Other…………………………………………………………..
TOTALS
SURPLUS INCOME
MONTHLY DISCRETIONARY EXPENSES: (Family Unit)
Housing Expenses
Living Expenses
Rent/Mortgage ...................................
Food/Grocery .......................................
Property Taxes/Condo Fees ..............
Laundry/Dry Cleaning/Grooming .........
Heating/Gas/Oil ..................................
Clothing ................................................
Telephone ..........................................
Cable ..................................................
Transportation Expense
Power/Water ......................................
Car Leases/Payments .........................
Other ..................................................
Repairs/Maintenance/Gas ...................
Public Transportation ...........................
Personal Expenses
Smoking .............................................
Insurance Expenses
Dining/Lunches/Restaurants ..............
Vehicle .................................................
Entertainment/Sports .........................
House ...................................................
Gifts/Charitable Donations .................
Furniture/Contents ...............................
Allowances .........................................
Life Insurance ......................................
Other ..................................................
Non-Recoverable Medical Expenses
Payments
Dental .................................................
To the estate
..
(to be completed by the Trustee)
Other ..................................................
To Secured Creditors ...........................
TOTAL MONTHLY DISCRETIONARY EXPENSES (FAMILY UNIT) ................................................................
(10)
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