BUDGET WORKSHEET 1555-B Eagle Drive, Mobile, AL 36605 Telephone (251) 434-2205 Fax (251) 434-2374 Complete as much information as possible. Please print. PERSONAL INFORMATION Last Name First Middle/Maiden Date of Birth Social Security Number Spouse Last Name First Middle/Maiden Date of Birth Social Security Number Address No. / Street City, State, Zip Code Previous Address (If less than 2 years) County Race: Residence Telephone Email Cell Phone INCOME PER PAY PERIOD (ONE PAY CHECK) - CLIENT Employer:________________________________________ Gross Income: $ _________________(before taxes) Payroll Deductions Position/Rank:____________________________________ Type Amount Telephone:_____________________________ Ext:______ Total Net Income: $___________________(after taxes) INCOME PER PAY PERIOD (ONE PAY CHECK) - SPOUSE Employer:________________________________________ Gross Income: $ _________________ Payroll Deductions Position/Rank:____________________________________ Type Amount Telephone:_____________________________ Ext:______ Total Net Income: Notes: $___________________ OTHER INCOME Source Garnishments/Judgements Source Total: $______________ Amount Total: $______________ Amount Client Name: _________________________________ COMMENTS Instructions: Fill in your estimated monthly expenses in the column marked "estimate". For your expenses, use recent monthly bills to average your expenses. Monthly Living Expenses Fixed Expenses ESTIMATE Rent Payment $ $ $ $ Renter Insurance Car Payment #1 Car Payment #2 Childcare Tax Installments Child Support Savings Total Fixed Expenses Flexible Expenses $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Lawn / Home Security $ Cable TV $ Vacations / Travel $ Total Flexible Expenses $ Periodic Expenses $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Auto Insurance $ Car Maintenance/Oil/Lube/Tires $ Total Periodic Expenses $ $ $ $ $ $ $ $ $ $ $ $ $ Groceries / Toiletries Meals Out School Lunches Electricity / Oil / Gas Water / Sewage / Garbage Telephone / Mobile Phone / Beeper Family Clothing Occupational Expenses Dry Cleaning / Laundry Gasoline Bus Fare / Ride Shares / Parking School - Tuition / Supplies Barber / Beauty Shop Books / Newspaper / Magazine Movies /Sporting Events/Entertainment Gifts / Parties / Holidays Cigarettes / Tobacco / Alcohol Baby Sitter Hobbies / Club Dues Medical / Dental / Optical / Medication Church / Charities Pet Care Home Maintenance Life Insurance Health & Accident Insurance Married Divorced Single Widow Renting Buying Own Other Rent paid to: Is Rent Delinquent? Yes No VEHICLE INFORMATION Vehicle #1 Make Year Model Payment Due Date Condition: Good Balance Fair Poor Vehicle #2 Make Year Model Payment Due Date Condition: Good Balance Fair Poor DEPENDENTS Yes No # No. of federal Tax Exemptions Claimed: Total Expenses Instructions List current balances and account numbers for all debts. If you need additional space, please use a separate sheet. Monthly Payment Current Y/N Monthly Payment Current Y/N Monthly Payment Current Y/N Credit Card Debt Creditor Account Number Balance $ Total Monthly Payment Pay Day Lenders Creditor Account Number Balance $ Other Creditor Account Number Balance $ Total All Creditors Total Monthly Payment $ Section Totals add all income and subtract all judgements, garnishments and expenses to come to a total monthly overage or shortage Section Totals Monthly Take Home Income (pg1) Monthly Living Expenses (pg2) $ Total Over (+) of Short (-) $ $