MY CURRENT MONTHLY EXPENSES * 6. Expense: Amount: Expense: Amount: a. Rent/house payment Health Insurance $ n. $ b. Gas, water, trash, & Non-covered medical $ o. $ electricity (including medicine) c. $ p. $ Telephone Life insurance d. Internet $ q. $ Car payment e. $ r. $ Media Services, i.e. Car Insurance Cable/Satellite, etc. f. $ s. $ Child care Car fuel and maintenance Food g. $ $ Lawn care t. Union dues Charitable giving h. $ u. $ Household Expenses Pension plan i. $ v. $ 401(k) payments Dry cleaning j. $ w. $ Garnishments Other: k. $ x. $ Cigarettes Other: l. $ y. $ Alcohol m. $ z. $ TOTAL: * Place a check mark by all expenses which you are not currently paying.
MY CURRENT MONTHLY EXPENSES * 6. Expense: Amount: Expense: Amount: a. Rent/house payment $ n. Health Insurance $ b. Gas, water, trash, & electricity $ o. Non-covered medical (including medicine) $ c. Telephone $ p. Life insurance $ d. Internet $ q. Car payment $ e. Media Services, i.e. Cable/Satellite, etc. $ r. Car Insurance $ f. Child care $ s. Car fuel and maintenance $ g. Food $ t. Lawn care $ h. Union dues $ u. Charitable giving $ i. Pension plan $ v. Household Expenses $ j. 401(k) payments $ w. Dry cleaning $ k. Garnishments $ x. Other: $ l. Cigarettes $ y. Other: $ m. Alcohol $ z. TOTAL: $ * Place a check mark by all expenses which you are not currently paying.
AffidavitOfFinancialMeansOctober2016.docx