BANKRUPTCY BUDGET FORM

NAME ____________________________
how did you find my name?
email ______________________________
by giving me your email address, you consent to me sending you emails
from time to time, that relate to items of interest as well as your case
phone ______________________
cell phone ___________________
Date of Birth __________________________

__________________________
Current Income – TELL ME HOW OFTEN YOU ARE PAID,
PLEASE SEND ME A COPY OF your last two PAY STUBS
Describe any increase or decrease of more than 10% in any of the
following catagories anticipated to occur within the year following the
filing of this document: Provide a written statement disclosing
any reasonably anticipated increase in income or expenses
over the 12 month period following the filing of your
Bankruptcy petition date.
SCHEDULE I –
Debtor’s Marital Status: ____________________
List your Occupation and Employer:
Debtor #1
Occupation:
Employer:
Employer Address:
How long employed?
Debtor #2
Occupation:
Employer:
Employer Address:
How long employed?
List all dependents you are currently supporting:
Name: Age: Relationship to You: Reside at your
residence?
How many people reside in your household? _______________
If this is a joint bankruptcy, do you and your spouse currently live in and maintain
separate households? Yes [ ] No [ ]
If Yes, please make another copy of this expense sheet and attach a copy of the
current expenses for the debtor and a copy of the current expense for the
debtor’s spouse.
SCHEDULE J – REGULAR MONTHLY EXPENSES
Future Budget (Give estimated monthly household average): This is an
estimate of what you will be paying when the bankruptcy is filed.
1. Rent or home mortgage payment (include lot rent for mobile home)
Is property insurance included? Yes [ ] No [ ]
Are real estate taxes included? Yes [ ] No [ ]
$
2. Utilities: a. Electricity & Heating fuel $
b. Water & Sewer $
(You must itemize phone, cable and internet, even if bundled on one monthly
billing – you need to list each as separate charges.)
c. Telephone – Regular phones/land line service:
Cell Phones:___
$____________
d. Cable $
e. Internet $
f. Trash $
g. Other (Specify):________________________________
3. Home maintenance (repairs and upkeep) $
4. Food $
5. Clothing $
6. Laundry & Dry Cleaning (Laundry detergent, laundry mat costs, etc.) $
7. a. Medical and Dental expenses not paid for by insurance.
(do not include insurance premium payments here)
b. Prescriptions not paid for by insurance.
$
$
8. Transportation: gas, oil, oil changes, general maintenance, etc.
(do not include car payments or vehicle insurance here) $
9. Recreation (Clubs, entertainment, newspapers, magazines, etc.) $
10. Charitable Contributions (if claimed on tax returns) $
11. Insurance (not deducted from wages or included in home mortgage payments)
a. Homeowner’s or Renter’s insurance $
b. Life – all whole life premiums (insurance with cash surrender value) $
Life – all term life premiums (insurance with No cash surrender value)
c. Health $
d. Auto $
e. Other (Specify):__________________________________________ $
__________________________________________ $
12. Taxes (not deducted from wages or included in home mortgage payments):
(Specify):_______________________________________________
$
a. Vehicle taxes/registration/tags (divide last years total as shown on
your vehicle registration(s) by 12 to get monthly average)
$
13. Installment payments:
a. Auto: Paid to ________________________________________________ $
b. Other: Paid to ________________________________________________ $
c. Other: Paid to ________________________________________________ $
14. Alimony, maintenance and support paid to others $
15. Payments for support of additional dependents not living at your home $
16. Regular expenses from operation of business, profession, or farm
(Attach Detailed Statement) $
17. Other:
a. Child care expenses
b. Children’s school expenses (uniforms, enrollment fees, tuition, supplies,
lunches, etc) & any other educational expenses $
c. Personal care products and hair care $
d. School Loans $
e. Specify: $
f. Specify: $
g. Specify: $$$$
18. TOTAL MONTHLY EXPENSES: $
19. Describe any increase or decrease in expenditures reasonably anticipated to
occur within the year following the filing of this document:
________________________________________________________________
_____________________
________________________________________________________________
_____________________

BANKRUPTCY BUDGET FORM

Leave a reply