PROFIT SENSE INPUT FORMS

							JAMES T. SCHERER, CPA HIAWATHA, KS 66434

PERSONAL FINANCIAL REPORTS
NAME MARITAL STATUS NUMBER OF DEPENDENTS COUNTRY AGE PROFESSION OCCUPATION AND INCOME INFORMATION YOURSELF OCCUPATION DESCRIPTION EXPERIENCE LEVEL (LOW, MEDIUM, HIGH) MONTHLY GROSS WAGES FROM RECENT PAY STUB(S) PRE-TAX EXPENSE DEDUCTIONS (MEDICAL, DENTAL, FSA) PRE-TAX INVESTMENTS DEDUCTIONS (401K, ESPP) MONTHLY TAXABLE INCOME(WAGES - PRE-TAX DEDUCTIONS) MONTHLY INCOME TAXES (FED, STATE, LOCAL) MONTHLY AFTER-TAX INCOME (NET WAGES) OTHER NET INCOME PENSION INCOME SOCIAL SECURITY INCOME INVESTMENTS INCOME REAL ESTATE INCOME OTHER REGULAR INCOME MONTHLY HOUSEHOLD EXPENSES PLEASE NOTE EXACT AMOUNTS ARE NOT REQUIRED. APPROXIMATE MONTHLY VALUES ARE JUST FINE. FOOD: INCLUDE EXPENSES FOR FOOD AT HOME AND FOOD PURCHASED OUTSIDE OF THE HOME UTILITIES: INCLUDE EXPENSES FOR HEATING, COOLING, LIGHTING, WATER, & SEWAGE HOUSEHOLD EXPENSES: INCLUDE EXPENSES FOR MAINTAINING THE HOUSE/PROPERTY APPAREL: INCLUDE EXPENSES FOR CLOTHING, DRY CLEANING, ETC. TRANSPORTATION: INCLUDE EXPENSES FOR TRAVEL BY AIR, CAR, BOAT & RAIL GASOLINE: INCLUDE EXPENSES FOR GASOLINE HEALTHCARE: INCLUDE EXPENSES FOR PRESCRIPTION DRUGS, OFFICE VISITS AND OTHER MEDICAL CHARGES NOT COVERED BY INSURANCE ENTERTAINMENT: INCLUDE EXPENSES FOR MOVIES, PARKS, SHOWS, CONCERTS, ETC PERSONAL CARE: INCLUDE EXPENSES FOR PERSONAL CARE PRODUCTS, HAIRCUTS, ETC EDUCATION: INCLUDE EXPENSES FOR EDUCATION, DAYCARE, ETC INSURANCE: INCLUDE EXPENSES FOR LIFE, HEALTH, DISABILITY, AUTO, HOME, ETC OTHER: INCLUDE EXPENSES NOT COVERED BY OTHER CATEGORIES THE GRAY SECTIONS ONLY NEED TO BE COMPLETED IF YOU WANT A MORE DETAILED REPORT. SPOUSE STATE YOURSELF ZIP SPOUSE

JAMES T. SCHERER, CPA HIAWATHA, KS 66434

HOUSEHOLD ASSETS PLEASE NOTE EXACT AMOUNTS ARE NOT REQUIRED. APPROXIMATE MONTHLY VALUES ARE JUST FINE. CASH/CHECKING/SAVINGS/MONEY PUBLIC COMPANY STOCKS/BONDS MUTUAL FUNDS OR POOLED SECURITIES ALL OTHER LIQUID OR SEMI-LIQUID ASSETS ON HAND CASH VALUE - LIFE INSURANCE RETIREMENT ACCOUNTS APPROXIMATE VALUE OF PRIMARY RESIDENCE APPROXIMATE VALUE OF PERSONAL REAL ESTATE APPROXIMATE VALUE OF OTHER PERSONAL INVESTMENTS AUTOMOBILES FURNITURE/FIXTURES JEWELRY OTHER ASSETS HOUSEHOLD LIABILITIES ANY LOANS/LIABILITIES THAT APPEAR ON A CREDIT REPORT MONTHLY PAYMENT INTEREST RATE

NAME

CATEGORY

APPROXIMATE BALANCE

LOAN CATEGORIES: MORTGAGE/RENT ON PRIMARY RESIDENCE CREDIT CARD CAR LOAN STUDENT LOAN OTHER REAL ESTATE LOAN OTHER INSTALLMENT LOAN OTHER SHORT TERM LOAN OTHER LONG TERM LOAN