Income & Expense Statement - Print and fill in by hand or save to your computer and fill in using the Free Adobe Reader.
NAME:
MONTH:
NUMBER OF PEOPLE IN HOUSEHOLD:
INCOME O R OTHER MONIES RECEIVED DURING MONTH
YOU
SPOUSE
Take home pay
Commissions
Support/Alimony
Child Benefit/Family Allowance
E.I. Benefits
Social Assistance
Pension
Take-home pay
Commissions
Support/Alimony
Child Benefit/Family Allowance
E.I. Benefits
Social Assistance
Pension
Rental income
Interest/Dividends
W.C.B. Benefits
Net Self-employment income
(A)YOUR TOTAL INCOME
Rental income
Interest/Dividends
W.C.B. Benefits
Net Self-employment income
(B)SPOUSE'S TOTAL INCOME
$ 0.00
(A+B) TOTAL FAMILY INCOME
$ 0.00
$ 0.00
Help From Family
NON-DISCRETIONARY EXPENSES - RECEIPTS OR OTHER PROOF REQUIRED
Child Support
Spousal Support
Child Care
Medical Expenses
TOTAL
$ 0.00
DISCRETIONARY HOUSEHOLD EXPENSES
Rent/Mortgage
Entertainment
Property Tax
Household Insurance
Home Repairs
Hydr o
Heating (gas/oil)
Water
Gifts
Tobacco
Alcohol
Clothing
Laundry, Etc.
Grooming
Cable TV/Internet
Telephone
Food
Life Insurance
Home Insurance
Car Insurance
Vacations
Pet Care
Education/Training
Car Payment
Car Exp . (gas/oil)
TOTAL EXPENSES:
Parking
Public Transportation
Car Exp . (repairs)
Address:
Employer:
$ 0.00