Personal Information
     
   

Household Address:

City, State, Zip:

Telephone: 

  E-mail: 

Head of Household:

Name:   

Date of Birth:  

Spouse:

 Name:   
Date of Birth:  

Children and Other Dependents
Name:   
Date of Birth:  
Name:   
Date of Birth:  
Name:   
Date of Birth:  
Name:   
Date of Birth:  

Tax Information

Federal Filing Status:

  Exemptions:  Fed Tax Bracket: 

State Filing Status:

  Exemptions:  State Tax Bracket: 

Is college funding one of your goals? 

Head Income & Taxes

  

Salary:

 

Bonus:

  

Other:

Self Employment:

Fed Withholding:

State Withholding:

 

Other Withholding:

 
Spouse Income & Taxes

Salary:

 

Bonus:

 

Other:

 

Self Employment:

 

Fed Withholding:

 

State Withholding:

 

Other Withholding:

 
Savings

Retirement Plans:

 

Other Investments:

Expenses

Non Deductible Debt:

 

Living:

 
Tax Related Items

Capital Gain:

  5 Year Capital Gain: 

Itemized Deductions:

 

Do you have an special needs for the future, such as a wedding or major purchase?

 
                     

Taxable Assets

Head

Spouse

JTWROS/CP

Tenants In Common (TIC)

Trust or FLP

Cash:

 

 

 

 

 

CDs:

 

 

 

 

 

Stocks:

 

 

 

 

 

Bonds:

 

 

 

 

 

Mutual Funds:

 

 

 

 

 

Tax Deferred/Non-Taxable Assets

Head

Spouse

JTWROS/CP

Tenants In Common (TIC)

Trust or FLP

Annuities:

 

 

 

 

 

Bonds:

 

 

 

 

 

Money Market Funds:

 

 

 

 

 

Retirement

Head

Spouse

Annual Contribution

Index %

Employer Match %

Employer Max %

Head 401(k):

 

 

 

 

 

 

Spouse 401(k):

 

 

 

 

 

 

Head IRA:

 

 

 

 

 

 

Spouse IRA:

 

 

 

 

 

 

Head Roth IRA:

 

 

 

 

 

 

Spouse Roth IRA:

 

 

 

 

 

 

Other Retirement Plans

                  

Head:

 

 

 

 

 

 

Spouse:

 

 

 

 

 

 

Defined Benefit Plans

Monthly Amount

Index %

After Ret Index %

Age to Begin

Ownership

  

Benefit Plan #1:

 

 

 

 

 

  

Benefit Plan #2:

 

 

 

 

 

  

Benefit Plan #3:

 

 

 

 

 

Tangible Property

Value

Ownership

Primary Residence:

 

 

Second/Vacation Home:

 

 

Vehicle #1:

 

 

Vehicle #2:

 

 

Household Assets:

 

 

Investment Property:

 

 

Business:

 

 

Primary Residence

Loan Amount:

  Rate:   Payment:   No. Payments:   Loan Date:

2nd Loan Amount:

  Rate:   Payment:   No. Payments:   Loan Date:

Second/Vacation Home

Loan Amount:

  Rate:   Payment:   No. Payments:   Loan Date:

Investment Property

Loan Amount:

  Rate:   Payment:   No. Payments:   Loan Date:

Vehicles

Vehicle #1 Amount:

  Rate:   Payment:   No. Payments:   Loan Date:

Vehicle #2 Amount:

  Rate:   Payment:   No. Payments:   Loan Date:


Goal:  Financial Independence/Retirement
Is Head currently retired? 


Is Spouse currently retired? 

If you are not yet retired, at what age do you expect to stop working full time?  
Head:    Spouse: 
How much monthly income do you need during retirement? 
Do you want to retain any capital at the end of your retirement? 

Enter the amount in today's dollars that you wish to retain at the end of your retirement (leave this blank to retain all retirement assets): 
Head Mortality Age Override:  
Spouse Mortality Age Override:  
Do you expect to supplement your retirement income? If so, how much do you expect to earn monthly?  
Head:    Years Working Part Time: 
Spouse:    Years Working Part Time: 

Social Security/Other Government-Sponsored Retirement Benefits
Does Head expect to receive Government-Sponsored Retirement Benefits on earnings when retired? 

Does Spouse expect to receive Government-Sponsored Retirement Benefits on earnings when retired? 

What percent of Social Security retirement benefits (AIME%) does Head expect to receive (default is 100%)?:
What percent of Social Security retirement benefits (AIME%) does Spouse expect to receive (default is 100%)?:
Social Security benefits are automatically calculated. However, if you wish to override this calculated amount, or you need to input a non-Social Security benefit then enter the monthly benefit amount in today's dollars (Note that this amount will always be inflated from today through the benefit age below):  
Head:    Spouse: 
At what age do you wish to begin taking your Retirement benefits (Social Security or Other)?  
Head:    Default is 67   Spouse: 

 

Goal:  Survivor Needs
Do you currently have a will?
If so, please provide last update:

If so, please provide attorney's name:

Do you have life insurance?

 

Do you have disability insurance?

Please add anything else that we have not asked for:

 

 

Your Name: 
 
Your Email Address: