www.nolo.com © nolo Outstanding Debts Monthly Payment Amount Behind Rent or mortgage (include second mortgage, home equity loans) ■■ ■■ ■■ Utilities and telephone ■■ ■■ ■■ ■■ Transportation expenses car loans ■■ maintenance payments ■■ auto insurance ■■ ■■ ■■ Child care ■■ ■■ Alimony or child support ■■ ■■ Education expenses student loans ■■ ■■ tuition expenses ■■ ■■ Personal and other loans bank loans ■■ loan consolidator ■■ ■■ ■■ ■■ ■■ Lawyers’ or accountants’ bills ■■ ■■ ■■ F-1 Outstanding Debts © nolo www.nolo.com Outstanding Debts Monthly Payment Amount Behind Medical (doctors’ and hospital) bills ■■ ■■ ■■ ■■ Insurance homeowner’s or renter’s ■■ disability ■■ medical or dental ■■ life ■■ ■■ ■■ Credit and charge cards ■■ ■■ ■■ ■■ ■■ ■■ Department store charges ■■ ■■ ■■ ■■ ■■ Back taxes Federal ■■ State ■■ Other (such as property) ■■ Other unpaid bills ■■ ■■ ■■ ■■ ■■ ■■ TOTALS ■ $ ■ $ F-1 Outstanding Debts (cont’d) www.nolo.com © nolo s’yadnuS serutidnepxE tsoC s’yadnoM serutidnepxE tsoC s’yadseuT serutidnepxE tsoC s’yadsendeW serutidnepxE tsoC :latoTyliaD:latoTyliaD:latoTyliaD:latoTyliaD s’yadsruhT serutidnepxE tsoC s’yadirF serutidnepxE tsoC s’yadrutaS serutidnepxE tsoC rehtO serutidnepxE tsoC :latoTyliaD:latoTyliaD:latoTyliaD:latoTylkeeW F-2 Daily Expenditures for Week of ________________ www.nolo.com © nolo F-3 Monthly Income From All Sources 1234 Amount of Period covered Amount Source of Income each payment by each payment per month A. Wages or Salary Job 1: Gross pay, including overtime: $ Subtract: Federal taxes State taxes Social Security (FICA) Union dues Insurance payments Child support wage withholding Other mandatory deductions (specify): Subtotal $ Job 2: Gross pay, including overtime: $ Subtract: Federal taxes State taxes Social Security (FICA) Union dues Insurance payments Child support wage withholding Other mandatory deductions (specify): Subtotal $ Job 3: Gross pay, including overtime: $ Subtract: Federal taxes State taxes Social Security (FICA) Union dues Insurance payments Child support wage withholding Other mandatory deductions (specify): Subtotal $ © nolo www.nolo.com Monthly Income From All Sources (cont’d) 1234 Amount of Period covered Amount Source of Income each payment by each payment per month B. Self-Employment Income Job 1: Gross pay, including overtime: $ Subtract: Federal taxes State taxes Self-employment taxes Other mandatory deductions (specify): Subtotal $ Job 2: Gross pay, including overtime: $ Subtract: Federal taxes State taxes Self-employment taxes Other mandatory deductions (specify): Subtotal $ C. Other Sources Bonuses Dividends and interest Rent, lease or license income Royalties Note or trust income Alimony or child support you receive Pension or retirement income Social Security Other public assistance Other (specify): Total monthly income $ F-3 www.nolo.com © nolo F-4 Attn: Customer Service Date: Name(s) on account: Account number: To Whom It May Concern: I am writing to dispute the following charge that appears on my billing statement dated , 20 . Merchant’s name: Amount in dispute: I am disputing this amount for the following reason(s): As required by law, I have tried in good faith to resolve this dispute with the merchant. [Describe your ef- forts. __________________________________________________________________________________.] Furthermore, I wish to point out that this purchase was for more than $50 and was made [cross out one:] in the state in which I live/within 100 miles of my home. Please verify this dispute with the merchant and remove this item, and all late and interest charges attributed to this item, from my billing statement. Sincerely, [your signature] Name: Address: Home phone: www.nolo.com © nolo Attn: Customer Service Date: Name(s) on account: Account number: To Whom It May Concern: I am writing to point out an error that appears on my billing statement dated , 20 . Merchant’s name: Amount in error: The problem is as follows: I understand that the law requires you to acknowledge receipt of this letter within 30 days unless you correct this billing error before then. Furthermore, I understand that within two billing cycles (but in no event more than 90 days), you must correct the error or explain why you believe the amount to be correct. Sincerely, [your signature] Name: Address: Home phone: F-5 . bills ■■ ■■ ■■ ■■ Insurance homeowner’s or renter’s ■■ disability ■■ medical or dental ■■ life ■■ ■■ ■■ Credit and charge cards ■■ ■■ ■■ ■■ ■■ ■■ Department store charges ■■ ■■ ■■ ■■ ■■ Back taxes Federal ■■ State ■■ Other. Service Date: Name(s) on account: Account number: To Whom It May Concern: On , 20 , I received a copy of my credit report from . It lists my payments to you as delinquent. My past financial problems are behind. the following: If I make a lump sum payment, you agree to remove the negative information from my credit file associ- ated with the debt. If I agree to pay off the debt in installments, you agree