7. Property taxes Savings for the future 8. insurance Homeowner’s/Tenant’s RRSP 45. 9. Condominium fees 46. RESP Water, Sewer and garbage 10. 47. Other (Specify) House repairs, maintenance, 11. yard care Support payments (Specify for whom, Heat 12. whether tax deductible, voluntary or Electricity 13. pursuant of order) Telephone 14. 48. Support being paid in this case Other 15. (Specify) 49. Support being paid in any other case Household expenses Debt payments (other than mortgages) Food 16. 50. Meals outside the home 17. Other General household supplies 18. 51. Life or term insurance premiums 19. Hair care, toiletries and sundries 52. Banking, legal, accounting 20. Dry cleaning and laundry 53. Church, charitable donations 21. Furnishings and equipment 54. Entertainment and recreation 22. Other (Specify) 55. Vacation 56. Alcohol / tobacco Transportation 57. Other (Specify) 23. Public transit, taxis 24. Car insurance, registration and license G Total annual expenses G= 25. Gas and Oil 26. Parking Adjusted annual income (D, E or F) _____________ 27. Car repairs and maintenance Subtract 28. Other (Specify) Total annual expenses (G) ______________ Health ANNUAL SURPLUS / (DEFICIT) ______________ Medical and dental insurance 29. premiums (Not deducted at source) Health care 30. (physiotherapy, etc.) Drugs, prescriptions 31. Dental care 32. (including orthodontist) Optical care 33. (eyeglasses, contact lenses) Other 34. (Specify) Personal Clothing, footwear 35. 36. Educational expenses (self) (Specify) 37. Other (Specify) Children Clothing, footwear 38. allowances, gifts 39. Children’s School fees, books and supplies 40. School activities 41. (field trips, etc.) Activities, lessons and supplies 42. (music lessons, clubs, sports, bicycles) Child care, babysitting 43. Other 44. (Specify)
7. Property taxes 8. Homeowner’s/Tenant’s insurance 9. Condominium fees 10. Water, Sewer and garbage 11. House repairs, maintenance, yard care 12. Heat 13. Electricity 14. Telephone 15. Other (Specify) Household expenses 16. Food 17. Meals outside the home 18. General household supplies 19. Hair care, toiletries and sundries 20. Dry cleaning and laundry 21. Furnishings and equipment 22. Other (Specify) Transportation 23. Public transit, taxis 24. Car insurance, registration and license 25. Gas and Oil 26. Parking 27. Car repairs and maintenance 28. Other (Specify) Health 29. Medical and dental insurance premiums (Not deducted at source) 30. Health care (physiotherapy, etc.) 31. Drugs, prescriptions 32. Dental care (including orthodontist) 33. Optical care (eyeglasses, contact lenses) 34. Other (Specify) Personal 35. Clothing, footwear 36. Educational expenses (self) (Specify) 37. Other (Specify) Children 38. Clothing, footwear 39. Children’s allowances, gifts 40. School fees, books and supplies 41. School activities (field trips, etc.) 42. Activities, lessons and supplies (music lessons, clubs, sports, bicycles) 43. Child care, babysitting 44. Other (Specify) Savings for the future 45. RRSP 46. RESP 47. Other (Specify) Support payments (Specify for whom, whether tax deductible, voluntary or pursuant of order) 48. Support being paid in this case 49. Support being paid in any other case Debt payments (other than mortgages) 50. Other 51. Life or term insurance premiums 52. Banking, legal, accounting 53. Church, charitable donations 54. Entertainment and recreation 55. Vacation 56. Alcohol / tobacco 57. Other (Specify) G Total annual expenses G= Adjusted annual income (D, E or F) _____________ Subtract Total annual expenses (G) ______________ ANNUAL SURPLUS / (DEFICIT) ______________