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Current Monthly Expenses
Please fill in all of the following information completely. Submit a separate form if client's spouse maintains a separate household. Estimate the average monthly expenses of the client and client's family.

IMPORTANT: Do not use commas when filling in amounts. If the item doesn't apply to you, leave the amount as $0. Do not leave any amount blank.

below pertains to: Self   Spouse
Rent or home mortgage payment (include lot rented for mobile home) $
Are real estate taxes included? Yes   No
Is Property Insurance included? Yes   No
Utilities: Electricity and heating fuel (natural gas) $
Water and Sewer $
Telephone $
Other (cable, refuse, etc.): $
Home maintenance (Repairs and upkeep) $
Food $
Clothing $
Laundry and dry cleaning $
Medical and Dental expenses (co-pay, over the counter, prescription, etc.) $
Transportation (not including car payments, such as for gasoline, auto repairs) $
Recreation, clubs and entertainment, newspapers, magazines, etc. $
Charitable contributions $
Insurance (not deducted from wages or included in home mortgage payments)
Homeowner's or Renter's $
Life $
Health $
Auto $
Other: $
Taxes (not deducted from wages or included in home mortgage payments)
Specify type:

$
Installment payments (Do not list credit card debt)
Auto $
Other: $
Other: $
Alimony, maintenance, and support paid to others $
Other: $
TOTAL:

[Basic Information] [Current Asset Information] [Current Monthly Expenses] [Creditor Information]

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