| Prepared by: | Date Originally Prepared: | ||
|
ITEM |
PAID TO: |
MONTHLY AMT. |
PROPOSED AMT. |
|
Housing Costs |
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|
Mortgage or Rent |
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|
2nd Mortgage |
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|
Electric |
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|
Phone |
|||
|
Water/Sewer |
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|
Fuel gas or oil |
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|
Trash removal |
|||
|
Cable |
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|
Supplies |
|||
|
Maintenance/repairs |
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|
Other:___________________ |
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|
Automobile(s) |
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|
Payment 1 |
|||
|
Payment 2 |
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|
Insurance |
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|
Gas/oil |
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|
Maintenance |
|||
|
Licensing |
|||
|
Other:______________ |
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|
Insurance |
|||
|
Homeowners' |
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|
Auto |
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|
Life |
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|
Health |
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|
Disability |
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|
Other:______________ |
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|
Total, this page |
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