Taxpayer's Name: | Tax Year: |
Income description | Amount you paid | Total cost |
---|---|---|
Rent | ||
Fair market rental value | ||
Property taxes | ||
Mortgage interest expenses | ||
Renter's insurance | ||
Property insurance | ||
Utilities - Water | ||
Utilities - Heat | ||
Utilities - Electric | ||
Home phone used by all | ||
Home maintenance expenses | ||
Food eaten in the home | ||
Other home expenses | ||
HOME EXPENSE TOTALS |
Resources: | ||
---|---|---|
Total income received (taxable and nontaxable) | ||
Amount borrowed | ||
Amount in checking accounts at beginning of year | ||
Amount in checking accounts at end of year | ||
Amount in savings accounts at beginning of year | ||
Amount in savings accounts at end of year | ||
Amount available to the person for support | ||
Amount used by the person for their own support | ||
Amount used by the person for other purposes | ||
Expenses: | ||
The person's share of household expenses | ||
The person's clothing expenses | ||
The person's education expenses | ||
The person's unreimbursed medical and dental expenses | ||
The person's travel and recreation expenses | ||
The person's other expenses | ||
Total cost of the person's support for the year | ||
Did the person pay half of expenses? | ||
Half of the person's support expenses | ||
Amount provided by the person (includes home FMV if they owned) | ||
Did you (the taxpayer) pay half of expenses? | ||
Amount from others, including state, local or other welfare agencies | ||
Amount from you |