BUDGET QUESTIONS

1. How often do you get paid?

Husband: __________________ Wife: ____________________

2. What is the gross pay each period (before deductions)

Husband: __________________ Wife: ____________________

3. Amount, if any, received from overtime on average paycheck:

Husband: __________________ Wife: ____________________

4. What are the deductions per pay period for:

Husband Wife

(a) Payroll taxes (including

social security) $__________ $__________

(b) Insurance $__________ $__________

(c) Union dues $__________ $__________

(d) Other (specify) $__________ $__________

5. If self-employed: gross income

from business: $__________ $__________

6. From real property: $__________ $__________

7. Interest and dividends: $__________ $__________

8. Social security and other

government assistance: $__________ $__________

9. Pension and

retirement income $__________ $__________

10. Spousal support: $__________ $__________

11. Child Support: $__________ $__________

12. Other income: $__________ $__________

specify source

13. For any child support received: please write name, age, and relationship of each child for whom you receive support.

14. If you think that you income may increase or decrease more than 10% within the next year, describe why you think so, and the amount of the increase or decrease. (if you income is seasonal, put in which months are the 'good' and/or 'bad' season, and the amount of the monthly increase or decrease in income during this season.

MONTHLY EXPENSES

Husband Wife

15. Rent/mortgage payment: $___________ $____________

Are property taxes included? ____ ____

Is property insurance included? ____ ____

16. Home maintenance: $___________ $____________

17. Electricity, heating fuel: $___________ $____________

18. Water and sewer: $___________ $____________

19. Telephone: $___________ $____________

20. Garbage: $___________ $____________

21. Security: $___________ $____________

22. Cable: $___________ $____________

23. Other Utilities: _________ $___________ $____________

24. Food: $___________ $____________

25. Clothing: $___________ $____________

26. Laundry/ dry cleaning: $___________ $____________

27. Medical/ dental: $___________ $____________

28. Transportation: $___________ $____________

29. Recreation/ clubs/

entertainment/ newspapers/

periodicals/ books: $___________ $____________

30. Charitable Contributions: $___________ $____________

31. Homeowner's/

renter's insurance: $___________ $____________

32. Life insurance: (if not

deducted from paycheck) $___________ $____________

33. Health insurance: (if not

deducted from paycheck) $___________ $____________

32. Auto insurance: $___________ $____________

33. Other insurance: (if not

deducted from paycheck) $___________ $____________

34. Real estate taxes: (if not

escrowed with mortgage) $___________ $____________

35. Other taxes: (include estimated

quarterly taxes not deducted

from paycheck if you pay these)$___________ $____________

36. Auto installment payments: $___________ $____________

37. Other installment payments:

put name of item for which

payments are being made:

_________________ $___________ $_____________

_________________ $___________ $_____________

38. Child support paid: $___________ $_____________

39. Spousal support paid: $___________ $_____________

40. Other expenses:

_________________ $___________ $_____________

_________________ $___________ $_____________

_________________ $___________ $_____________

_________________ $___________ $_____________