38 Ill. Adm. Code 1075.APPENDIX A
A Estimated Monthly Income and Expenses Worksheet
Section 1075
Section 1075.APPENDIX A
Estimated Monthly Income and Expenses Worksheet
ESTIMATED MONTHLY INCOME:
1.
Paycheck (Net/"Take Home")
$
2.
Interest/Dividends
3.
Social Security/Pension
4.
Alimony/Child Support
5.
Other
6.
Total Estimated Monthly Income
$
(Add Lines 1 through 5)
ESTIMATED MONTHLY EXPENSES:
7.
Mortgages/Rent
$
8.
Homeowner's/Renter's Insurance
9.
Real Estate Taxes
10.
Water & Sewer
11.
House Repairs
12.
Groceries
13.
Telephone
14.
Gas (House)
15.
Electric
16.
Credit Cards
17.
Car Payments
18.
Car Insurance
19.
Licenses (Car)
20.
Gas (Car)
21.
Car Repairs/Maintenance
22.
Clothing
23.
Medical/Dental
24.
Medical Insurance
25.
Prescriptions
26.
Loan Payments
(Not included in Line 2 or 17)
27.
Tuition
28.
Contribution
29.
Cellular Telephone
30.
Pager
31.
Recreation/Vacation
32.
Other Insurance (Life, etc.)
33.
Income Taxes
34.
Alimony/Child Support
35.
Transportation
36.
Miscellaneous
37.
Other
38.
Total Estimated Monthly Expenses
$
(Add Lines 7 through 37)
39.
*Excess/Deficit
$
(Subtract Line 38 from Line 6)
*If Line 38 is greater than
Line 6, your estimated monthly expenses exceed your estimated monthly income.