PERSONAL BUDGET WORKSHEET

Please use monthly dollar amounts complete the budge worksheet below.

Your responses will be securely uploaded to our team upon submission.

Your Information

Spouse 1: First and Last Name

Spouse 2: First and Last Name

Phone

Working Monthly Net (After Tax) Income

Spouse 1

Working Monthly Net (After Tax) Income

Commissions & Bonuses

Interest Income & Dividends (Savings, CD, Bonds, Stocks, etc.)

Gifts (Inheritance, Trust Fund, etc)

Spouse 2

Working Monthly Net (After Tax) Income 2

Commissions & Bonuses 2

Interest Income & Dividends (Savings, CD, Bonds, Stocks, etc.) 2

Gifts (Inheritance, Trust Fund, etc) 2

Retirement Income

Spouse 1

Alimony &/or Child Support

Pension(s) & Life Annuities

Social Security

IRA Distributions

Rental Income Net Expenses

Misc.

Spouse 2

Alimony &/or Child Support 2

Pension(s) & Life Annuities 2

Social Security 2

IRA Distributions 2

Rental Income Net Expenses 2

Misc. 2

Household Expenses

Mortgage Principal & Interest

Utilities - Gas/Electric

Real Estate Taxes

Water - Sewer

Homeowners Insurance

Cable - Phone - Internet

Rent

Cell Phones

Rental Insurance

House Cleaning

Maintenance - Supplies - HOA

Misc. Household Expenses

Transportation Expenses

Auto Loan 1

Fuel

Auto Loan 2

Repairs

Auto Insurance

Misc. Transportation Expenses

Daily Living Expenses

Groceries

Salon - Massage - Manicure

Dining - Eating Out

Misc. Daily Living Expenses

Clothing - Dry Cleaning - Laundry

Health Expenses

Spouse 1

Health Insurance/ Medical Supplement Plan

Medicare Part D

Life Insurance

Disability Insurance

LTC Insurance

Medicine - Drugs

Veterinarian - Pet Care

Misc. Health Expenses

Spouse 2

Health Insurance/ Medical Supplement Plan 2

Disability Insurance 2

Life Insurance 2

Medicine - Drugs 2

LTC Insurance 2

Medicare Part D 2

Entertainment Expenses

Home - Shows - Events

Sports - Hobbies - Lessons

Dues - Memberships

Vacation - Travel

Misc. Entertainment Expenses

Debts - Loans

Credit Cards

Alimony - Child Support Payments

Student Loans

Misc. Debts and/or Loans

Charity - Gifts

Charitable Donations

Gifts - Birthday - Holidays

Misc. Charity and/or Gifts

Additional Information

Please use this space to add any additional relevant information and explain any expected changes in your income and expenses over the next 20 years: