Mediating Divorce Agreement

DOMESTIC RELATIONS MEDIATION BUDGET FORM

Name:                                                                
Date:              

I.   Home

A.   Mortgage payments

    1.   Principal                                                                                

    2.   Interest                                                                           
 
    3.   Taxes                                                                             

    4.   Special assessments                                                                               

B.   Apartment rental                                                                               

C.   Home repairs/major cleaning                                                                                

D.   Furniture/Appliance maintenance                                                                                

E.   Heating fuel                                                                                

F.   Utilities  

    1.   Electricity                                                                                

    2.   Water/garbage/sewer                                                                                 

    3.   Telephone                                                                                

    4.   Grounds maintenance                                                                                

G.   Homeowners/Renters insurance                                                                                

H.   Domestic help (housekeeper, etc.)                                                                              

II.  Personal Maintenance

A.   Food (including eating out)                                                                           

B.   Clothing                                                                         

C.   Laundry/dry cleaning                                                                         

D.   Medical

    1.  Medical insurance                                                                         

    2.  Additional medical costs                                                                        

    3.  Dental costs                                                                          

    4.  Eye care/glasses                                                                         

    5.  Mental health                                                                         

    6.  Prescriptions  
                                                                               
E.  Hair care                                                                         

F.   Recreation   

1.  Vacation savings                                                                       

    2.  Summer camp/equipment                                                                         

    3.  Membership dues                                                                          

    4.  Allowances, children                                                                         

    5.  Entertainment                                                                         

G.   Education/self improvement     

    1.  Magazines and  newspapers                                                                         

    2.  Records and books                                                                           

    3.  Tuition, classes, etc.                                                                       

H.   Insurance/retirement  

    1.  Life insurance  premiums                                                                         

    2.  Accident/disability                                                                         

    3.  Retirement account                                                                         

I.   Child care                                                                         

J.   Contributions                                                                            

K.   Gifts (birthdays, Christmas)  
                                                                       
L.   Transportation

    1.  Auto maintenance gas                                                                          

    2.  Bus passes                                                                         

    3.  Carpool payments, etc.                                                                            

    4.  Loan repayment                                                                         

    5.  Auto insurance       

                                                                
    6.  Repairs allowance                                                                       

    7.  Registration, license, DEQ
        expense, etc.                                                                         

M.   Savings allowance                                                                        

N.   Bank charges                                                                        

O.   Additional debt payments 
 
    1.                                                                                                           
    2.                                                                                                             
    3.                                                                                                             
    4.                                                                                                             
    5.                                                                                                             
    6.                                                                                                             
    7.                                                                                                             
    8.                                                                                                             

P.   Miscellaneous expenses

1.  Tailor, cobbler sundries                                                                    

    2.  Pets - food,
        medical, grooming, etc.