$ Your Spouse $ Utilities (electricity, heating fuel, water, sewer and telephone) Home maintenance (repairs & upkeep) Food Clothing Laundry and dry-cleaning Medical and dental expenses Transportation (not including motor vehicle payments) Recreation, entertainment, newspapers, magazines, etc. Insurance (not deducted from wages or included in Mortgage payments) · Homeowner’s or renter’s · Life · Health · Motor Vehicle · Other: ________________________________________________ Taxes (not deducted from wages or included in Mortgage payments) (Specify: ________________________________________________) Installment payments · Motor Vehicle · Credit card (name): · Department Store (name): · Other: _________________________________________________ Alimony, maintenance, and support paid to others Regular expenses for operation of business, profession, or farm (attach detailed statement) Other (specify): ___________________________________________ Total Monthly Expenses: 9. Do you expect any major changes to your monthly income or expenses or in your assets or liabilities during the next 12 months?

Vegas Law