(a) Housing
1 Rent...............................
2 Mortgage & amortization............
3 Real estate taxes..................
4 Condominium charges................
5 Cooperative apt maintenance........
Housing Total:.............
(b) Utilities
1 Fuel Oil...........................
2 Gas................................
3 Electricity........................
4 Telephone..........................
5 Water..............................
Utilities Total:...........
(c) Food
1 Groceries..........................
2 School lunches.....................
3 Lunches at work....................
4 Liquor/alcohol.....................
5 Home entertainment.................
6 Other..............................
Food Total:................
(d) Clothing
1 Husband............................
2 Wife...............................
3 Children...........................
4 Other..............................
Clothing Total:............
(e) Laundry
1 Laundry at home....................
2 Dry cleaning.......................
3 Other..............................
Laundry Total:.............
(f) Insurance
1 Life...............................
2 Homeowner's/tenant's...............
3 Fire,theft & liability.............
4 Automotive.........................
5 Umbrella policy....................
6 Medical plan & FSA.................
7 Dental plan........................
8 Optical plan.......................
9 Disability.........................
10 Worker's Compensation..............
11 Other..............................
Insurance Total:...........
(g) Unreimbursed medical
1 Medical............................
2 Dental.............................
3 Optical............................
4 Pharmaceutical.....................
5 Surgical,nursing, hospital.........
6 Other..............................
Unreimbursed medical Total:
(h) Household maintenance
1 Repairs............................
2 Furniture,furnishing,household.....
3 Cleaning supplies..................
4 Appliances,including maintenance...
5 Painting...........................
6 Sanitation/carting.................
7 Gardening/Landscaping..............
8 Snow removal.......................
9 Extermination......................
10 Other..............................
Household maintenance Total:
(i) Household help
1 Babysitter.........................
2 Domestic(housekeeper,maid,etc).....
3 Other..............................
Household help Total:......
(j) Automotive
Year Make Personal/Business
1 Payments...........................
2 Gas & Oil..........................
3 Repairs............................
4 Car Wash...........................
5 Registration & license.............
6 Parking & tolls....................
7 Other..............................
Automotive Total:..........
(k) Educational
1 Nursery & pre-school...............
2 Primary & secondary................
3 College............................
4 Post-graduate......................
5 Religious instruction..............
6 School transportation..............
7 School supplies & books............
8 Tutoring...........................
9 School events......................
10 Other..............................
Educational Total:.........
(l) Recreational
1 Summer camp........................
2 Vacations..........................
3 Movies.............................
4 Theatre,ballet,etc.................
5 Video rentals......................
6 Tapes,CDs,etc......................
7 Cable Television...................
8 Team sports........................
9 Country club/pool club.............
10 Health club........................
11 Sporting goods.....................
12 Hobbies............................
13 Music/dance lessons................
14 Sports lessons.....................
15 Birthday parties...................
16 Other..............................
Recreational Total:........
(m) Income taxes
1 Federal............................
2 State..............................
3 City...............................
4 Social Securtiy & Medicare.........
Income taxes Total:........
(n) Miscellaneous
1 Beauty parlor/barber...............
2 Beauty aids/cosmetics/drug items...
3 Cigarettes/tobacco.................
4 Books,magazines,newspapers.........
5 Children's allowances..............
6 Gifts..............................
7 Charitable contributions...........
8 Religious organization dues........
9 Union & organization dues..........
10 Commutation & transportation.......
11 Veterinarian/pet expenses..........
12 Child support payment..............
(prior marriage)
13 Loan payments......................
14 Unreimbursed business expenses.....
Miscellaneous Total:.......
(o) Other
1 ..............
2 ..............
3 ..............
4 ..............
Other Total:...............
TOTAL EXPENSES:....
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