| INCOME | MONTHLY AMOUNT | PERCENT | NOTES | |
| YOUR NAME AND JOB | $ 2,133.00 | 102.98% | Name & ages of children | |
| Federal Tax Withheld | $ 61.63 | 2.98% | Susie, age 13 | |
| Spouse's name & job | $ - | 0.00% | Johnny, age 8 | |
| Federal Tax Withheld | 0.00% | Judy, age 6 | ||
| TOTAL INCOME | $ 2,071.37 | 100.00% | Ronnie, age 4 | |
| EXPENDITURES | ||||
| Housing | ||||
| Mortgage | $ 370.00 | 17.86% | ||
| Taxes | $ 100.00 | 4.83% | ||
| Insurance | $ 84.00 | 4.06% | ||
| Electricity/Gas | $ 130.00 | 6.28% | ||
| Water/Sewage | $ 30.00 | 1.45% | ||
| Garbage | $ 12.00 | 0.58% | ||
| Telephone | $ 36.00 | 1.74% | 1 land line | |
| Cell phone (optional) | $ 89.99 | 4.34% | 2 cell phones | |
| Internet | $ 19.95 | 0.96% | basic DSL | |
| Additional TV service | $ 19.95 | 0.96% | family channel | |
| TOTAL HOUSING | $ 891.89 | 43.06% | ||
| Transportation | ||||
| Car #1 Payment | $ 350.00 | 16.90% | ||
| Car #2 Payment | $ - | 0.00% | ||
| Gas/Maintenance | $ 125.00 | 6.03% | ||
| Car Insurance | $ 140.00 | 6.76% | ||
| TOTAL TRANSPORTATION | $ 615.00 | 29.69% | ||
| Personal | ||||
| Food | $ 100.00 | 4.83% | $100 maximum | |
| Clothing | $ 100.00 | 4.83% | $100 maximum | |
| Health Insurance | $ 75.00 | 3.62% | $75 for myself | |
| Life Insurance | $ 30.00 | 1.45% | for self only | |
| Entertainment | $ 80.00 | 3.86% | for 5 with 1 teenager | |
| Miscellaneous | $ 85.00 | 4.10% | for 5 with 1 teenager | |
| Giving to church | $ 40.00 | 1.93% | ||
| Savings | $ 54.48 | 2.63% | ||
| TOTAL PERSONAL | $ 564.48 | 27.25% | ||
| TOTAL INCOME | $ 2,071.37 | 100.00% | ||
| TOTAL EXPENDITURES | $ 2,071.37 | 100.00% | ||