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Budget Application

Basic Information


Income
Income YTD
Gross Other
$ $
Taxes YTD
Federal State Social Sec Med Other
$ $ $ $ $
Deductions YTD
401k Medical Dental Vision Life Ins ST Disab LT Disab Flex Spend Other
$ $ $ $ $ $ $ $ $
Totals % of Gross Income
Total Gross Income $0
Total Taxes $0 0%
Total Deductions $0 0%
Net Income $0
Home Expenses
January February March April May June July August September October November December
Mortage/rent $ $ $ $ $ $ $ $ $ $ $ $
2nd mortage $ $ $ $ $ $ $ $ $ $ $ $
Home/renters insurance $ $ $ $ $ $ $ $ $ $ $ $
Tax $ $ $ $ $ $ $ $ $ $ $ $
Gas & electric $ $ $ $ $ $ $ $ $ $ $ $
Cable/phone/internet/fax $ $ $ $ $ $ $ $ $ $ $ $
Cell phone $ $ $ $ $ $ $ $ $ $ $ $
Water/trash $ $ $ $ $ $ $ $ $ $ $ $
Home repairs & improvements $ $ $ $ $ $ $ $ $ $ $ $
Furnishings & appliances $ $ $ $ $ $ $ $ $ $ $ $
Lawn & garden $ $ $ $ $ $ $ $ $ $ $ $
Other $ $ $ $ $ $ $ $ $ $ $ $
Daily Living
January February March April May June July August September October November December
Groceries $ $ $ $ $ $ $ $ $ $ $ $
Child care/sitting $ $ $ $ $ $ $ $ $ $ $ $
Dry cleaning $ $ $ $ $ $ $ $ $ $ $ $
Pet food $ $ $ $ $ $ $ $ $ $ $ $
Housecleaning services $ $ $ $ $ $ $ $ $ $ $ $
Clothing $ $ $ $ $ $ $ $ $ $ $ $
Salon/barber $ $ $ $ $ $ $ $ $ $ $ $
Other $ $ $ $ $ $ $ $ $ $ $ $
Transportation
January February March April May June July August September October November December
Total of car payments $ $ $ $ $ $ $ $ $ $ $ $
Gas $ $ $ $ $ $ $ $ $ $ $ $
Auto insurance $ $ $ $ $ $ $ $ $ $ $ $
Auto repairs $ $ $ $ $ $ $ $ $ $ $ $
Auto maintenance $ $ $ $ $ $ $ $ $ $ $ $
Wash & detail $ $ $ $ $ $ $ $ $ $ $ $
Registration and licensing $ $ $ $ $ $ $ $ $ $ $ $
Parking $ $ $ $ $ $ $ $ $ $ $ $
Public transporation $ $ $ $ $ $ $ $ $ $ $ $
Taxi service $ $ $ $ $ $ $ $ $ $ $ $
Other $ $ $ $ $ $ $ $ $ $ $ $
Entertainment
January February March April May June July August September October November December
DVD rentals $ $ $ $ $ $ $ $ $ $ $ $
Movies & plays $ $ $ $ $ $ $ $ $ $ $ $
Eating out $ $ $ $ $ $ $ $ $ $ $ $
Sports fees $ $ $ $ $ $ $ $ $ $ $ $
Concerts and clubs $ $ $ $ $ $ $ $ $ $ $ $
Vacation and travel $ $ $ $ $ $ $ $ $ $ $ $
Tobacco & alcohol $ $ $ $ $ $ $ $ $ $ $ $
Other $ $ $ $ $ $ $ $ $ $ $ $
Health
Yes No
January February March April May June July August September October November December
Health & dental insurance $ $ $ $ $ $ $ $ $ $ $ $
Prescription & OTC drugs $ $ $ $ $ $ $ $ $ $ $ $
Co-payments $ $ $ $ $ $ $ $ $ $ $ $
Health club dues $ $ $ $ $ $ $ $ $ $ $ $
Vet visits $ $ $ $ $ $ $ $ $ $ $ $
Other $ $ $ $ $ $ $ $ $ $ $ $
Charity/Gifts
January February March April May June July August September October November December
Donations $ $ $ $ $ $ $ $ $ $ $ $
Gifts $ $ $ $ $ $ $ $ $ $ $ $
Other $ $ $ $ $ $ $ $ $ $ $ $
Savings
January February March April May June July August September October November December
Long term $ $ $ $ $ $ $ $ $ $ $ $
Retirement $ $ $ $ $ $ $ $ $ $ $ $
401k $ $ $ $ $ $ $ $ $ $ $ $
IRA $ $ $ $ $ $ $ $ $ $ $ $
Other $ $ $ $ $ $ $ $ $ $ $ $
Financial Obligations
January February March April May June July August September October November December
Credit card payments $ $ $ $ $ $ $ $ $ $ $ $
Student loans $ $ $ $ $ $ $ $ $ $ $ $
Child support $ $ $ $ $ $ $ $ $ $ $ $
Tuition $ $ $ $ $ $ $ $ $ $ $ $
Life insurance/LT & ST Disabilities $ $ $ $ $ $ $ $ $ $ $ $
Other $ $ $ $ $ $ $ $ $ $ $ $
Emergency Savings
January February March April May June July August September October November December
Short term $ $ $ $ $ $ $ $ $ $ $ $


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