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CUSTOMER NAME:

Monthly Income Homeowner Amount


Wages/Take Home 0
Overtime 0
Commissions/Bonus 0
Unemployment Income 0
Child Support/Alimony 0
Social Security/Disability 0
Other (Rental Income) 0
Total Total 0

Monthly Expenses Amount


Primary mortgage payment 0
Other Mortgage payments 0
Real Estate Tax & HO Insurance 0
HOA/Fees/Dues 0
Home Maintenance 0
Automobile Loans-List All 0
Automobile Insurance-List All 0
Automobile Gas/Maintanence/etc 0
Personal Loans-List All 0
Student Loans 0
Other Cards monthly payments 0
Insurance (health/Life) 0
Doctor Bills / Medical Bills / RX 0
Education/Tution/Book Expense 0
Day care/Baby sitting 0
Alimony/Child Support 0
Grocery 0
Pet expenses & others 0
SUB TOTAL 0
Utilities
Cable TV 0
Electricity 0
Natural Gas 0
Telephone/Cell Phones 0
Sewer/Water 0
Internet 0
Other: Tuition/books 0
Spending money 0
TOTAL 0
Comments:
Monthly Income Co-Homeowner Amount
Wages/Take Home 0
Overtime 0
Commissions/Bonus 0
Unemployment Income 0
Child Support/Alimony 0
Social Security/Disability 0
Other (Please Explain) 0
Total 0

Assets
Type Estimated Value
Home
Other Real Estate
All Checking/Savings Accts.
Stock/Bonds/Mutual Funds
Care IRA/Keogh Accounts
Other
ities
TOTAL INCOME 0

TOTAL EXPENSE 0

DEFICIT/SUPLUS 0