SCHEDULE B Employed By City & State Occupation Pay Period Next Payday Salary/Wage # Exemptions Children in Household Name Age HOUSEHOLD Mortgage or Rent Real Estate Property Taxes Homeowner's Insurance Repairs/Maintenance Furniture UTILITIES Electricity Gas/Heating Oil Water/Sewer Telephone Trash Cable TV FOOD Groceries Lunches AUTOMOBILE Payment/Depreciation Gasoline Repairs, Tags, Inspection Auto Insurance Parking/Other Transportation Personal Property Tax CHILDCARE EXPENSES Child Care School Tuition Lunch Money Lessons/Sports New Clothing Average Gross Pay/Month LESS: State Taxes FICA Health Insurance Life Insurance Required Retirement Avg. Monthly Net Pay Other Income MONTHLY NET INCOME CLOTHING New (Excluding Children) Cleaning/Laundry Uniforms HEALTH EXPENSES Doctor Dentist Therapist Eyeglasses Hospital Medicines Other DUES Professional Associations Social Associations Homeowner's Association MISCELLANEOUS Gifts (Xmas, Birthday) Church/Charity Entertainment Vacations Hobbies Personal Grooming Newspaper/Magazines Disability Insurance Life Insurance (Both H & W) Legal Expenses Fixed Debts With Payments Balance TOTALS PER MONTH Subtotal Expenses Subtotal Debt Payments Monthly Pmt. TOTAL EXPENSES TOTAL NET INCOME BALANCE (+) BALANCE (-) Charge Account Debt Balance Monthly Pmt. LIQUID ASSETS ON HAND Cash/Checking/Savings Other Liquid Assets TOTAL LIQUID ASSETS Total Debt Payments Submitted By: American LegalNet, Inc. www.FormsWorkflow.com