Expense Breakdown Example, CWL-4611
| |
|EXPENSE BREAKDOWN EXAMPLE |
|(For Optional Use) |
|Michigan Department of Health and Human Services |
|Division of Child Welfare Licensing |
| |
|Please use monthly figures (optional form) |
|Mortgage/Rent | |Dependent Care/ Child Care | |Medical Insurance | |
|Property Taxes | |Donation/ Charity/ Tithing | |Life Insurance | |
|Homeowners/ Renters Insurance | |Credit Cards | |Prescriptions/ Medical Expenses | |
|Heat/Utilities/Water/ Waste | |Child Support | |Health Club Memberships | |
|Home Repairs (misc). | |Allowance/Spending | |Long Term Care | |
|Household Supplies (hygiene, | |Food/Groceries | |Internet/TV | |
|cleaning products etc.) | | | | | |
|Domestic Services (housekeeping/ | |Gifts (birthdays/ holidays etc.) | |Auto Maintenance/ Upkeep | |
|lawn care etc.) | | | |(registration, license etc.) | |
|Auto Payment | |Hobbies | |Travel | |
|Auto Insurance | |Alimony | |Subscriptions | |
|Gas/Transportation Costs | |Personal Care (haircut, nails etc.) | |Savings/Investments | |
|Second/Vacation Home Payment | |Recreation Payments (RV, boat, ATV | |Smoking | |
| | |etc.) | | | |
|Home Equity Loans/ Personal Loans | |Clothing | |Phone/Cell Phones(s) | |
|Other/Miscellaneous | | | | | |
|Total: | |Total: | |Total: | |
| |
|Grand Total: | | |
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| |
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|The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group because of race, religion, age, national origin, |
|color, height, weight, marital status, genetic information, sex, sexual orientation, gender identity or expression, political beliefs or disability. |
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