Amended Budget

Instructions

The forms necessary to prepare the amended budget that must be filed are below. Complete the following page with your income, dependent information and monthly expenses. Email, mail, or fax copies of your two (2) most recent pay stubs, and proof of any other income such as bank statements reflecting deposits of pension or social security income. If your expenses differ significantly from the Trustee`s Guidelines shown next to the budget items, please explain briefly. Fill out the budget worksheets and proof of income as soon as possible. Please note: You are authorizing us to make changes in the budget which may be necessary to be consistent with the pay stubs, proof of other income, Trustee`s Guidelines and the required plan payment.

Your full names:

Section 5 - Current Income

Marital status:
Not married. Complete only column A for you.
Married & filing jointly. Complete column A for husband & B for wife.
Married, living together, but spouse is not filing. You must complete column A for you & column B for spouse.
Married, living separate & apart from spouse, and spouse is not filing. Complete only column A for you.

A - You (Husband)

B - Spouse (Wife)

Employer:

Street address:

City: State: Zip:

Position:

Hire date:

Position:

Hire date:

How often paid:
Weekly;
Biweekly;
Semi-monthly;
Monthly

Gross monthly income	$
Monthly tax deductions	$
Monthly insurance deductions	$
Monthly retirement deductions	$
Monthly retirement loan deductions	$
Monthly charity deductions	$
Monthly support deductions	$
Other monthly deductions	$
Other monthly deductions	$
Net monthly take home pay	$

Gross monthly income	$
Monthly tax deductions	$
Monthly insurance deductions	$
Monthly retirement deductions	$
Monthly retirement loan deductions	$
Monthly charity deductions	$
Monthly support deductions	$
Other monthly deductions	$
Other monthly deductions	$
Net monthly take home pay	$

Other Income

A - You (Husband)		B - Spouse (Wife)
Monthly self-employment income	$	Monthly self-employment income	$
Monthly social security income	$	Monthly social security income	$
Monthly pension/retirment income	$	Monthly pension/retirment income	$
Monthly rental income	$	Monthly rental income	$
Monthly child support income	$	Monthly child support income	$
Monthly spousal support income	$	Monthly spousal support income	$
Monthly government assistance - Food stamps, etc.	$	Monthly government assistance - Food stamps, etc.	$
Monthly unemployment income	$	Monthly unemployment income	$
Monthly contributions to household expenses by others	$	Monthly contributions to household expenses by others	$
Other monthly income Source:	$	Other monthly income Source:	$
Do you anticipate any increase or decrease in any of the above income categories within the 12 months following the filing of your case? No; Yes If yes, explain:

Dependents; None

In the section below, list all dependents that live with you in your residence and that you financially support. The dependent must live with you AND you must financially support to be listed below.

Name	Age	Relationship to you
		Son; Daughter; Grandchild; Other:
		Son; Daughter; Grandchild; Other:
		Son; Daughter; Grandchild; Other:
		Son; Daughter; Grandchild; Other:
		Son; Daughter; Grandchild; Other:

Section 6 - Current monthly living expenses

If you do not have an expense, enter 0 in the box.

Category	Monthly Expense	Trustee`s Allowance	Explanation if expense exceeds trustee`s allowance
Rent	$
Mortgage	$
Second Mortgage	$
Mobile home space rent	$
Property tax (if not included in mortgage)	$
Property insurance (if not included in mortgage)	$
Homeowners association Monthly; Quarterly	$
Home maintenance (must own home to be allowed)	$	$100 *Must own home to claim
Electric	$	$330
Gas	$	$115
Water/Sewer/Trash	$	$90
Telephone	$	$150
Food	$
Clothing	$	$80 per person/dependent
Laundry/cleaning	$	$25
Medical/dental/prescriptions (*Out-of-pocket)	$	Actual 12 month average that can be proven with receipts	You must attach proof of 12 month average to claim over 50.
Transportation/gas/oil/repairs	$	$340 if 1 vehicle; $680 if joint with 2 vehicles; $75 w/o vehicle
Recreation	$	$150 single; $220 joint
Miscellaneous contingency	$
Charity/church tithing	$	*Attach proof of the amount of the premium
Renters insurance*	$	*Attach proof of the amount of the premium
Vehicle insurance*	$	*Attach proof of the amount of the premium
Life insurance NOT deducted from pay*	$	*Attach proof of the amount of the premium
Health insurance NOT deducted from pay*	$	*Attach proof of the amount of the premium
Taxes NOT deducted from pay	$
Vehicle lease	$	*Attach proof of the monthly payment
Vehicle payments (*Chapter 7 only)	$
Other payments (*Chapter 7 only) Specify:	$
Child support NOT deducted from pay	$
Spousal support NOT deducted from pay	$
Child care expenses	$	Actual amount that can be proven

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