* = required field

Person 1 Person 2
* Name
  
 
Income
 Person 1 Person 2 Joint
Wages or Salary
  
Bonus
  
Business Income
  
Social Security
  
Trust Income
  
Rental Income
  
Child Support Received
  
Alimony Received
  
Other wages or salary
  
 
Liability Payments and Balances
 Person 1 Person 2 Balance Due
(if applicable)
Alimony
  
Auto Payments - Lease
  
Auto Payments - Loan
  
Child Support
  
Credit Card(s)
  
Home Equity Loan
  
Mortgage (Principal and Interest)
  
Personal Loan(s)
  
Student Loan(s)
  
Other liabilities
  
 
Household Expenses
 Person 1 Person 2 Joint
Auto Maintenance
  
Automobile Fuel
  
Cable TV or Internet
  
Charitable Contributions
  
Child Care or Day Care
  
Clothing
  
Dining Out or Take Out
  
Dry Cleaning
  
Entertainment
  
Gifts
  
Groceries
  
Health Insurance
  
Hobbies
  
Homeowner Insurance
  
Insurance co-pay or deductibles
  
Memberships
  
Personal Care
  
Phone or Cell Phone
  
Prescriptions
  
Property or School Taxes
  
Travel or Vacations
  
Utilities
  
Other expenses
  
 
Taxes
 Person 1 Person 2 Joint
Federal Income Tax
  
State Income Tax
  
Self Employment Tax
  
Social Security or FICA