FORM 4 - BUDGET
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PART A. GENERAL EXPENSES

  
Name 
Rent or Home Mortgage__________________________________
  Real estate taxes included          Property insurance included 
Utilities: Electricity and heating fuel_________________________
                Water__________________________________________
                Telephone_______________________________________
                Other  
Home maintenance________________________________________
Food____________________________________________________
Clothing_________________________________________________
Laundry and dry cleaning___________________________________
Medical and dental expenses________________________________
Check here if a joint petition is filed and debtor's spouse 
      maintains a separate household. 
Transportation (not including car payments)____________________
Recreation, entertainment__________________________________
Charitable contributions____________________________________

PART B. INSURANCE (not deducted from wages or included in home mortgage payments)
Homeowner's or renter's____________________________________
Life_____________________________________________________
Health___________________________________________________
Auto____________________________________________________
Other  
 PART C. TAXES (not deducted from wages or included in home mortgage payments)
(Specify)   
PART D. INSTALLMENT PAYMENTS: ( in Chapter 13 cases, do not list payments to be included in the plan.)
Auto_____________________________________________________
Other____________________________________________________
Other____________________________________________________
Other____________________________________________________
PART E. ALIMONY: (support for dependents and misc. expenses)  
Alimony, maintenance, and support paid to others_______________
Payment for support of additional dependents not living at your home____________________________________________________
Regular expenses from operation of business, profession, or farm_____________________________________________________
Other 
Other 

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