Fraud Aid Solution Center Printable Document
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NAME: DATE: MONTHLY INCOME Do you juggle your bills
each month, paying one but not another? [ ] Yes [ ] No Are you living off your
credit cards or other line of credit? [ ] Yes [
] No Are you receiving
financial assistance from a friend or relative? [ ] Yes [ ]
No Do you have seasonal
expenses like clothing for school, high heating bills, and high
air-conditioning bills? [ ] Yes [ ] No Income 1 Income 2 Extra income 1. Total monthly
income 2. (-minus) Expenses 3. Balance HOUSING Cost ENTERTAINMENT Cost Mortgage or rent Video/DVD Phone CDs Electricity Movies Gas Concerts Water and sewer Sporting events Cable Live theater Waste removal Other Maintenance or repairs Other Supplies Other Other Subtotal Subtotal TRANSPORTATION Cost LOANS Cost
Total Owed Vehicle payment
Personal Bus/taxi fare Student Insurance Credit card Licensing Credit card Fuel Credit card Maintenance Medical Other Other Subtotals Subtotals INSURANCE Cost TAXES Cost
Total Owed Home Federal Health State Life Local Other Other Subtotal Subtotals FOOD Cost SAVINGS OR INVESTMENTS Cost Groceries Retirement account Dining out Investment account Other Other Subtotal Subtotal PETS Cost GIFTS &
DONATIONS Cost Food Medical Charity 1 Toys Charity 2 Grooming Charity 3 Other Subtotal Subtotal PERSONAL CARE Cost LEGAL Cost Medical Attorney Hair/nails Alimony Clothing Child Support Dry cleaning Payments on lien or
judgment Health club Restitution Organization dues or
fees Other Subtotal Subtotal
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