Yourself
Others
Employment Income (Take-Home)
Net Self Employment Income
Net E.I. Benefits
Pension / Annuities
Child Tax Credit
Universal Child Care Benefits
Net Spousal / Child Support
Rental Income
Assistance from Family/Friends
Other:____________________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
TOTAL NET MONTHLY INCOME
$__________
$__________
Net Monthly Income
$
Monthly Non-Discretionary Expenses
Child Support Payments
Spousal Support Payments
Child Care
Medical Expenses
Fines/Penalties by the Court
Employment Related Expenses
Other:________________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
NON-DISCRETIONARY EXPENSES
$__________
$__________
$
Monthly Discretionary Expenses for the Family Unit
Housing Expenses
Rent/Mortgage
Property Taxes/ Fees
Heating/Gas/Oil
Hydro
Water
Home Telephone
Cell Phone
Cable
Internet
Personal Expenses
Smoking
Alcohol
Lunches/Dining Out
Entertainment/Sports
Gifts/Donations
Kids Allowances
Misc
Bankruptcy Fees
Other:______________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
Non-Recoverable Medical Expenses
Details:____________
$__________
Living Expenses
Food
$__________
Laundry/Dry Cleaning
$__________
Grooming/Toiletries
$__________
Clothing
$__________
Transportation Expenses
Car Payments
$__________
Repairs/Maintenance
$__________
Gasoline
$__________
Public Transportation
$__________
Insurance Expenses
Vehicle
$__________
House
$__________
Contents
$__________
Life
$__________
Proposal Payments
Other:______________
$__________
$__________
TOTAL MONTHLY DISCRETIONARY EXPENSES - Family Unit
$
MONTHLY SURPLUS OR (DEFICIT) - Family Unit
$
Name:
For the month of:
Signature:
Date:
www.rumanek.com
Tel: 416-665-3328 (DEBT) Fax: 416-665-9081 [email protected]
Head Office: 1280 Finch Avenue West, Suite 714, Toronto, Ontario M3J 3K6
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