Income and Expense Worksheet *Monthly Combined Household Income includes that of Client, Co-Client, Spouse, or any other contributor to the overall household income.
Monthly Income Monthly Combined Household Income*: Other Income [Alimony, Child Support, Etc.]:
Please include all recurring monthly expenses as accurately as possible. The provided information will be utilized to determine the extent of your personal financial hardship and will assist us during the negotiations process with your creditors or collectors.
Monthly Cost of Living Expenses Housing
Utilities [Gas, Electric, Water, Etc.]
Telephone – Home/Cellular
Television – Cable/Satellite
Health Club Membership Fees
CD’s, DVD’s, Books, Etc.
Current Credit Card Payments
Retirement [401K, IRA]
Public Parking Fees
Liens, Levy’s, Garnishment(s)
Groceries Child Care/Day Care Laundry/Dry Cleaning Education/School Supplies
Life/Health/Dental Health Insurance Life Insurance
Co-Payments/Out of Pocket Prescriptions/Medications Dental Care
Apple Law Group - Rev 030912
$ 0.00 $ 0.00