| Monthly Income | Budget | Actual | |
| Social Security | $ | $ | |
| Pension | $ | $ | |
| Investment interest | $ | $ | |
| Investment dividends | $ | $ | |
| Annuities | $ | $ | |
| Part-time job | $ | $ | |
| Other | $ | $ | |
| Total Monthly Net Income | $ | $ | |
| Monthly Expenses | |||
| Rent/mortgage | $ | $ | |
| Insurance/taxes | $ | $ | |
| Telephone | $ | $ | |
| Electricity | $ | $ | |
| Garbage/recycling | $ | $ | |
| Water and Sewage | $ | $ | |
| Cable/Internet | $ | $ | |
| Credit Card Fees, Interest | $ | $ | |
| Groceries | $ | $ | |
| Restaurant meals | $ | $ | |
| Auto loan | $ | $ | |
| Auto insurance | $ | $ | |
| License/registration | $ | $ | |
| Gas | $ | $ | |
| Medical expenses | $ | $ | |
| Prescriptions | $ | $ | |
| Elder care | $ | $ | |
| Life/health insurance | $ | $ | |
| Travel/entertainment | $ | $ | |
| Charity/gifts | $ | $ | |
| Clothing | $ | $ | |
| Savings | $ | $ | |
| Total Monthly Expenses | $ | $ | |
| Net Income or Loss | $ | $ |
