Section
1050.APPENDIX A Estimated Monthly Income and Expenses Worksheet
ESTIMATED
MONTHLY INCOME:
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1.
|
Paychecks
(Net/Take Home)
|
$
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2.
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Interest/Dividends
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3.
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Social
Security/Pension
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4.
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Alimony/Child
Support
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5.
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Other
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6.
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Total
Estimated Monthly Income (Add Lines 1 through 5)
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$
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ESTIMATED MONTHLY EXPENSES:
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7.
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Mortgages/Rent
|
$
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8.
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Homeowner's/Renter's
Insurance
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9.
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Real
Estate Taxes
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10.
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Water
& Sewer
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11.
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House
Repairs
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12.
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Groceries
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13.
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Telephone
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14.
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Gas
(House)
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15.
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Electric
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16.
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Credit
Cards
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17.
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Car
Payments
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18.
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Car
Insurance
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19.
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Licenses
(Car)
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20.
|
Gas
(Car)
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21.
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Car
Repairs/Maintenance
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22.
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Clothing
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23.
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Medical/Dental
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24.
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Medical
Insurance
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25.
|
Prescriptions
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26.
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Loan
Payments (Not included in Line 7 or 17)
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27.
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Tuition
|
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28.
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Contributions
|
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29.
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Cellular
Telephone
|
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30.
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Pager
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31.
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Recreation/Vacation
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32.
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Other
Insurance (Life, etc.)
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33.
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Income
Taxes
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34.
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Alimony/Child
Support
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35.
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Transportation
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36.
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Miscellaneous
|
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37.
|
Other
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38.
|
Total
Estimated Monthly Expenses (Add
Lines 7 through 37)
|
|
|
$
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39.
|
*Excess/Deficit
(Subtract Line 38 from Line 6)
|
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$
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* If Line 38 is greater than Line 6, your estimated
monthly expenses exceed your estimated monthly income.
(Source: Amended at 29 Ill. Reg. 14808, effective September 26, 2005)