BANKRUPTCY WORKSHEET: YOUR INCOME

Fill Out Completely and Print Out.	DEBTOR	JOINT DEBTOR
Current monthly gross wages, salary, commissions (pro-rate if not paid monthly)	$	$
Estimated monthly overtime	$	$
Payroll taxes and Social Security deducted	$	$
Insurance deducted	$	$
Union dues deducted	$	$
Other payroll deductions - specify	$	$
Regular monthly income from business, profession, or farm (attach a detailed statement)	$	$
Monthly income from real property	$	$
Monthly interest and dividends	$	$
Alimony, maintenance, or support payments (amt. Received monthly for debtor's or debtor's dependents' use)	$	$
Social Security or government assistance	$	$
Pension or retirement	$	$
Other monthly income	$	$
Describe any increase or decrease of ore than 10% in any previous category anticipated to occur in the year following this filing	$	$
INCOME TOTALS:	$	$