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Housing	at GVM	Currently
Mortgage/Rent	Included	$________
Real Estate Taxes	Included	$________
Homeowner's Insur.	Included	$________
Electric	Included	$________
Gas/Oil/Other	Included	$________
Cable TV	$20.00	$________
Trash Collection	Included	$________
Maint./Repairs	Included	$________
Lawn/Trees	Included	$________
Security System	Included	$________
	Subtotal	$________
Food
Groceries	Included	$________
Dining Out	Included	$________
	Subtotal	$________
Activities
Entertainment	Included	$________
Memberships	Included	$________
	Subtotal	$________
Automobile
Gas/Oil	Included	$________
Maint./Repairs	Included	$________
Insurance	Included	$________
Reg./Inspec.	Included	$________
	Subtotal	$________
Care
Home Health/Other	Included	$________
Grand Total		$________

Grand View Manor, 129 Houck Road, Fleetwood, PA 19522 Phone: (610) 944-1800   Toll Free: (866) 944-1800   Fax: (610) 944-5200

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