Financial Resources, Expenses, and Debts

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Marylou Summers
5 years ago
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1 Financial Resources, Expenses, and Debts Name: Today s Date: INCOME FROM EMPLOYMENT Fill in for each job that you are currently working. Job #1 Employer s Name: Address where you work: Describe what do you do: What date did you start: How are you paid? HOURLY Hours per week Rate per hour $ SALARY What is the GROSS pay on each paycheck? (Gross pay is more than you actually take home) $ How often are you paid? Every week Every two weeks Twice per month Once per month

2 Job #2 Employer s Name: Address where you work: Describe what do you do: What date did you start: How are you paid? Employer s Name: Address where you work: Describe what do you do: What date did you start: How are you paid? HOURLY Hours per week Rate per hour $ Job #3 HOURLY Hours per week Rate per hour $ SALARY What is the GROSS pay on each paycheck? (Gross pay is more than you actually take home) $ How often are you paid? Every week Every two weeks Twice per month Once per month SALARY What is the GROSS pay on each paycheck? (Gross pay is more than you actually take home) $ How often are you paid? Every week Every two weeks Twice per month Once per month

3 OTHER SOURCES OF INCOME List all other sources of income or government benefits that you receive Child support received by you Spousal support received by you Alimony received by you SSI Food stamps WIC TANF Disability income Section 8 Rent paid to you Royalties paid to you

4 LIVING EXPENSES Rent Renter s insurance House payment Property taxes HOA dues Property insurance Cell phone Electricity Natural gas Trash Sewer Water Lawn maintenance Pest control Pool maintenance Housekeeping Household supplies Groceries Eating out School lunches Hair and grooming Nails Cigarettes/Vape/etc. Beer, wine, liquor Gambling recreation: Car payment Car insurance Tolls Parking Car maintenance Registration fee Bus/Cab fare transportation expense Health insurance Medications Doctor s visits (co pays) medical: medical: medical Your clothing Children s clothing Private school fees Sports fees activity fees Children s entertainment Adult education Child care expenses Child support you pay Spousal support you pay Alimony you pay expense: expense: expense: expense:

5 DEBTS List each debt you owe Name of person/company you owe Total Amount You Owe Minimum Monthly Payment Amount You Actually Pay Each Month (if any)

6 ASSETS List each item of value that you have. You can list household furnishings as one item. Description Household furnishings Value (not what you paid what it s worth) Clothing Motor vehicle: Motor vehicle: Motor vehicle: Firearms (total) House: House: Land: Land: 401(K) Account: 401(K) Account: IRA Account: IRA Account: Cash in the bank: Cash in the bank: Cash in your hands Collection: : : :

7 ATTEMPTS TO BORROW MONEY List each person or company from whom you have tried to borrow money. This list only needs to cover people or companies you ve tried to borrow from so you can pay your child support. Date Applied/Asked Person or Company Amount Borrowed JOBS APPLIED FOR List each job you have applied for since you started getting behind on child support. Date Applied Person or Company Position Applied For Result PLEASE RETURN THIS FORM IN THE ENVELOPE THAT WAS PROVIDED. IF YOU DON T HAVE THE ENVELOPE, YOU CAN SEND IT BACK ANY OF THESE WAYS: MAIL: Power Daley PLLC, Dallas Parkway Ste 101, Dallas, TX FAX: cm@powerdaley.com

Monthly Expenses Worksheet

Monthly Expenses Worksheet Education Rent or mortgage $ Tuition $ Heating (gas or oil) $ Books, papers and supplies $ Electricity $ Newspapers and magazines $ Water or sewage $ Lessons (sports, dance,