Income and Expense Statement for:

Time Period:
Income
Earned Income
Wages or salary before deductions
Total Income
Expenses
Deductions Often Taken from Paychecks
Contribution to a retirement program (401k, 403b)
Federal Income Tax
Social Security
Medicare
State Income Tax
Saving and Investing (Pay Yourself First)
Contribution to savings and investments
Emergency Savings
Insurance Premiums
Health insurance, Medicaid and Medicare
Renters or homeowners insurance
Automobile insurance
Housing Costs
Housing payment (rent or mortgage)
Utilities (gas, electricity, water, garbage)
Transportation Costs
Automobile payment
Fuel (gasoline/diesel)
Automobile repairs and maintenance
Automobile license and registration (yearly fee)
Food Costs
Food at the grocery store
Meals at restaurants
Snacks away from home (coffees, treats)
Nonfood kitchen supplies (plastic wrap, dish soap)
Communication and Computers
Cell phone
Internet
Cable/satellite television
Medical Costs Not Covered by Insurance
Medical care
Clothing and Personal Care
Clothing
Personal care (shampoo, haircuts, cosmetics, laundry,
Entertainment

Month

3,464.00

467.61
214.76
50.22
147.25
145.16
200.00

10.00
125.00
599.00
250.00
250.00
200.00
50.00
10.00
450.00
60.00
10.00
45.00
20.00
50.00
30.00
80.00

Movies, books, and other entertainment

Total Expenses
Net Gain or Net Loss (Income less Expenses)

3,464.00
-

or:
Year

41,570.00

5,611.32
2,577.12
602.68
1,766.96
1,741.92
2,400.00

120.00
1,500.00
7,188.00
3,000.00
3,000.00
2,400.00
600.00
120.00
5,400.00
720.00
120.00

540.00
240.00
600.00
360.00
960.00

41,570.00