Placer — Monthly Budget Form

Source: https://www.placer.courts.ca.gov/sites/default/files/pl-fl028.pdf

Monthly Spending

Use Average Monthly numbers

What I spend now What I really need
per MONTH per MONTH
(removing or cutting back to
less than what I spend now)

Rent or Mortgage
$ $
Utilities - gas, electric, water, garbage $ $
Insurance - Homeowner's or renter's $ $
Other home costs (repairs, upgrades, etc) $ $

Groceries
$ $
Household supplies (like cleaners) $ $

Cell phone or landline
$ $

Clothes & Shoes $ $

Car payment
$ $
Gas $ $
Insurance $ $
Maintenance (Oil changes, tires, tune-ups) $ $

Cable
$ $
Internet $ $

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Form Adopted for Optional Use www.placer.courts.ca.gov Superior Court of California, County of Placer Page 1 of 2 Form No. PL-FL027 Effective 03-01-2020

Streaming services $ $

Child care
$ $

Insurance – Health
$ $

Co-pays, deductibles, prescriptions $ $

Life insurance
$ $

Entertainment

Eating out $ $
Movies $ $
Kids’ extracurricular activities $ $
Gifts $ $
Other: $ $

Other Savings $ $ Credit cards $ $ Other loans or debt $ $ $ $ $ $ $ $ $ $

TOTAL COSTS $ $

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Form Adopted for Optional Use www.placer.courts.ca.gov Superior Court of California, County of Placer Page 2 of 2 Form No. PL-FL027 Effective 03-01-2020