176x Filetype XLSX File size 0.45 MB Source: www.secnav.navy.mil
Personal Financial Statement Full Name: Date: This form is also available at: http://www.ncis.navy.mil/securitypolicy/DONCAF/Pages/default.aspx Monthly Income: Assets: Gross Salary Real Estate Net Salary (take home) Retirement Accounts Spouse's Gross Income Car/Boat/Vehicles etc. Spouse's Net Salary Stocks/Bonds Other Income Checking/Savings Miscellaneous Total Net Monthly Income $0 Total Assets $0 Monthly Expenses Housing Insurance Primary Mortgage/Rent Life Mobile Home(s) Disability HOA Fee Renters/Fire Mortgage Medical/Health 2nd Mortgage Other Insurance Investment/Add'l Home Insurance Subtotal Home Equity Loan $0 Housing Subtotal $0 Education Utilities Tuition/Fees Electric Books Water/Sewer Supplies LP Gas/Fuel Oil/Nat Gas Other (specify) Trash Service Education Subtotal Cable/Satellite TV Internet Service $0 Home/Mobile Phone Entertainment Utilities Subtotal $0 Movies/Plays/Theater Clubs/Sports/Hobbies Medical Gifts Doctor Other (Specify) Dentist Vet&Pet Supplies Entertainment Total $0 Medication Other (Specify) Personal Allowances Medical Subtotal $0 Barber/Salon Cigarettes/Tobacco Clothing Charity Donations Personal Other (Specify) Family (Inc Uniforms) Dry Cleaning/Laundry Personal Subtotal $0 Other (Specify) Clothing Subtotal $0 Other Expenses Alimony Food Child Support Groceries Child Care Dining Out/Delivery Elder Care School/Work Lunches Family Support Pet Grooming/Kennel Food Subtotal $0 Other Not Listed Automobile Other Subtotal $0 Insurance Fuel Repairs/Tires Etc Taxes Taxi/Van Pool/Parking Toll Road Other (Specify) Automobile Subtotal $0 Total Monthly Expenses: List all expenses/debts to include but not limited to: loans against 401k plans or similar retirement accounts, auto loans/leases, recreational vehicles, boats, motorcycles, timeshares, student loans, family loans, credit union(s), finance company(ies), bank loans, signature loans and credit cards. List each account separatley by name of person company/firm. Include all debts for which you are obligated as a co-signer. Do not include in this section, mortage; second mortages, home equity loans, etc, this should be included in the housing section. Continue on a separate sheet of paper if necessary. Debt Name Amount Owed Monthly Payment TOTALS: $0 $0 Total Net Monthly Income: $0 Monthly Living Expenses: $0 Monthly Debt Payments: $0 Remainder: $0
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