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Income and expense form
Income and expense form
Date: 03/08/2021
Due by the 12th of the following month.
Print version
Month of:
*
January
February
March
April
May
June
July
August
September
October
November
December
Monthly income and expense statement
Debtor
*
First
Last
Email
Marital status
Married/Common law
Single
Spouse
First
Last
Address
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Employer
*
If you are self employed please write "self"
Employer - Spouse
Number of dependents
*
Age of dependents
*
Monthly (family) gross income from all sources
Myself
Spouse
Monthly (family) net wages from all sources
Myself
*
Spouse
*
Child tax benefit
Myself
*
Spouse
*
Other Sources of Income:
*
EI
Social assistance
Borrowings
Part time earnings
Pension
Child or Spousal Support
None
Other
Please provide details
Value of above selection (myself)
*
Value of above selection (spouse)
*
Total net monthly income
Attach any pay statement
Drop files here or
Accepted file types: jpg, pdf, doc, jpeg, png, docx.
Monthly (family) living expenses
Do not upload receipts, but retain.
Housing
Rent/Mortgage
Utilities
Household maintenance
Telephone
Taxes/Condo fees
Other
Specify other expenses
eg: Other - $100, Other, $200
Sub total - Housing
Personal
Food/Toiletries
Drycleaning
Baby supplies
Daycare
Clothing
Grooming
Entertainment
Alcohol
Tobacco
School fees
Alimony/Support
Other
Specify other expenses
eg: Other - $100, Other, $200
Subtotal - Personal
Medical
Drugs
Dentist
Other
Specify other expenses
eg: Other - $100, Other, $200
Attach receipts
Drop files here or
Accepted file types: jpg, jpeg, pdf, doc, docx, png.
Sub total - Medical
Insurance
Life
Auto
Blue Cross
House/Contents
Other
Specify other expenses
eg: Other - $100, Other, $200
Sub total - Insurance
Travel
Vehicle payment
Bus/Carpool
Gas/Maintenance
Other
Specify other expenses
eg: Other - $100, Other, $200
Sub total - Travel
Totals
Total monthly expenses
Surplus income deficit
Payment to trustee
Comments
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Email
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