CDMN
Average Monthly Expenses and Income
Please use your take home pay after all deductions.
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CDMN |
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Average Monthly Expenses and Income Please use your take home pay after all deductions.
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Take Home Pay #1: |
$ |
Retirement: |
$ |
|
Take Home Pay #2: |
$ |
ADFC: |
$ |
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Other Income (Support/Stamps): |
$ |
Social Security: |
$ |
|
TOTAL Monthly Income$ |
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| Necessary Expenses: | |||
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Rent or Mortgage |
$ | ||
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Electricity |
$ | ||
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Home Gas |
$ | ||
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Home Telephone |
$ | ||
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Water |
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Food/Groceries |
$ | ||
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Transportation: |
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Car Payment |
$ | Misc. Expenses: | |
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Car Insurance |
$ |
Vacations |
$ |
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Gasoline |
$ |
Dining |
$ |
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Commuting Expenses |
$ |
Movies/Sports |
$ |
|
Child Care |
$ |
Books/Magazines |
$ |
|
Clothing |
$ |
Fees and Dues |
$ |
|
Laundry/ Dry Cleaning |
$ |
Pets |
$ |
|
Personal Care/Haircuts |
$ |
Supplies |
$ |
|
School Bills (Tuition/Supplies) |
$ |
Other 1 |
$ |
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Insurance--Medical & Dental |
$ |
Other 2 |
$ |
|
Insurance--Life, Health |
$ |
Other 3 |
$ |
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Taxes: |
Other 4 |
$ | |
|
IRS |
$ |
Other 5 |
$ |
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State |
$ |
TOTAL Misc. Expenses: |
$ |
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Property |
$ | ||
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Other Expenses: |
TOTAL Monthly Income: |
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Media (Internet, TV ,Paper) |
$ |
$ |
|
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Cell phone/Pagers |
$ |
(-) TOTAL Monthly Expenses: (Necessary + Misc.) |
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Installment Payments |
$ | $ | |
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Other 1 |
$ |
(-) CDMN/HCCS Payment: |
|
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Other 2 |
$ | $ | |
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TOTAL Expenses: |
$ |
(=) TOTAL (Shortage) or Savings: |
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| $ | |||
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Client Name: |
Spouse Name: |
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Client Signature: |
Spouse Signature: |
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Date: |
Date: |
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Consumer Debt Management Northeast, Inc. Copyright © 2001 [CDMN]. All rights reserved.