Personal Annual Budget # 1201

Name:_____________________________________ Date:____________________________

Instructions:
To get a better idea of your annual revenue and expenses, complete this form below.

REVENUE
Net salary $ ________________
Interest, investment income $ ________________
Unemployment insurance benefits ________________
Social assistance ________________
Family allowances ________________
Support payments from ex-spouse ________________
Parental or family contribution ________________
Government student loans ________________
Scholarships and awards ________________
Credit balance in bank account ________________
Other revenue ________________
TOTAL ________________
EXPENSES
Housing
Rent or mortgage payments ________________
Electricity ________________
Maintenance and repairs ________________
Cable TV/ subscription TV ________________
Telephone ________________
Insurance ________________
Other housing expense ________________
TOTAL ________________
Transportation
Car (vehicle) loan payment ________________
Car, gas and oil ________________
Car maintenance and repairs ________________
Car insurance ________________
Car registration fee ________________
Parking ________________
Public transportation ________________
TOTAL ________________
Living Expenses
Groceries ________________
Food away from home ________________
Clothing ________________
Sundries (newspapers, magazines) ________________
Cigarettes ________________
Entertainment ________________
Phyisical, sporting activities ________________
Personal grooming ________________
Pocket money ________________
Medical expenses ________________
TOTAL ________________
Tuition Fees and Books
Tuition and fees ________________
Books and materials ________________
TOTAL ________________
Other Expenses
Loan payments (other than car loan) ________________
Credit cards ________________
Other ________________
TOTAL ________________
SUMMARY ________________
TOTAL REVENUE ________________
TOTAL EXPENSES ________________
BALANCE ________________
This form may be copied for personal use by active members of myADHD.com. For further information refer to: www.myADHD.com.

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