For International Paper Employees, or affiliated companies
where International Paper holds a majority interest, ONLY

Family Budget Form

You may print this form and fill it out by hand, or you can type in the information online and then print the form.

Initials (Please enter your initials here)

Date

Expenses (per month)

Monthly Amount Owed

Past Due Balance

Rent/Mortgage

$

$

Food

$

$

Heat (gas, oil)

$

$

Clothing

$

$

Insurance, Car

$

$

Insurance, Renters/Home

$

$

Insurance, Medical

$

$

Credit Cards/Loans

$

$

Telephone

$

$

Cable TV

$

$

Car Payment

$

$

Child Care

$

$

Other, Please List:

$

$

$

$

$

$

$

$

Total

$

$

Monthly

Annually

Employment - Self

$

$

Employment - Spouse/other members of household

$

$

State Assistance

$

$

Social Security

$

$

Pension

$

$

Child Support

$

$

Food Stamps

$

$

Other: ________________________

$

$

Total

$

$

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