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