Knowing Where You Stand

Cash Flow Statement–Instructions



Put in the amount of your gross earnings from your paycheck(s), and other income, such as pension income, investment income, alimony & child support received, as well as gifts.

Salary and wages

Total from all sources

Bonuses, commissions, tips

Total from all sources

Self-employment income

Total from all sources

Interest and dividends

Include this only if the total is more than $200

Alimony/child support received

Total amount

Gifts received

Total amount

Pension income

Total amount

Social Security income

Total amount

Public assistance, unemployment and/or disability benefits

Total amount

Other income: _______________

All other income


Total the income amounts above.




Whatever amount you are saving and investing. Include the amount you put into your 401(k), IRAs, and other retirement accounts.

Federal & state taxes

Enter the amount for federal and state taxes. Include Social Security, Medicare, and local tax. Use your pay stub, or use the amount from your last year's tax return if you're using Statement II and you don't expect many changes in your taxable income. Note: Due to your decrease in income, you may be able to subtract a little.

Mortgage or rent

What you pay, not including taxes and insurance. If your mortgage payment includes taxes and insurance, leave those lines blank below.

Home repair/maintenance

Any maintenance and repairs on your home or apartment, condo fees, etc.

Property taxes

Real estate (and in some states) personal property taxes

Disability Insurance

Include any insurance premiums deducted from your paycheck

Life insurance

Include any insurance premiums deducted from your paycheck

Home/renter's insurance

Premium payments

Auto insurance

Premium payments

Credit card/loan payment

Loans other than your mortgage, including car loans and credit card payments

Utilities & telephone

Water, telephone, electricity, gas, garbage, sewer, etc.

Food (include dining out)

All food and restaurants


All clothes


Hair care, beauty supplies, etc.


Gas for automobiles and other modes of transportation

Auto repair/maintenance

Major repairs, oil changes, new tires, etc.

Other transportation

Tolls, train fare, bus fare, etc.

Medical care

Medical and Dental expenses not covered by insurance, including health insurance premiums deducted from your paycheck and all other health insurance premiums.


Tuition and fees, room and board, meal plans, etc.

Child care

All costs for babysitting and child care expenses

Alimony/child support

Amounts paid


Sporting events, hobbies, movies, etc.


Including airplane fare

Gifts/charitable contributions

Gifts to charitable organizations, gifts to relatives and friends


Amount spent

Other: _____________________

All other items of outflow unique to your situation.


Total the outflow amounts above.


Subtract outflow from income

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Securities and advisory services are offered through LPL Financial (LPL), a registered investment advisor and broker-dealer (member FINRA/SIPC. Insurance products are offered through LPL or its licensed affiliates. Premier America Credit Union and Premier America Investment & Retirement Services are not registered as a broker-dealer or investment advisor. Registered representatives of LPL offer products and services using Premier America Investment & Retirement Services, and may also be employees of Premier America Credit Union. These products and services are being offered through LPL or its affiliates, which are separate entities from, and not affiliates of Premier America Credit Union or Premier America Investment & Retirement Services. CA Insurance License #0759204, TX Insurance License#1643255.

Securities and insurance offered through LPL or its affiliates are:

Not Insured by NCUA or Any Other Government Agency Not Credit Union Guarantee Not Credit Union Deposits or Obligations May Lose Value