Personal And Financial Information Form Page 3
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4Financial Information Sheet
It is very important you indicate in each category ownership and dollar amount separately, as well as total value.**
**
MONTHLY INCOME:
SOURCE
YOU
SPOUSE
JOINT
TOTAL
Wages
$
$
$
$
Pension
$
$
$
$
Social Security
$
$
$
$
Investments
$
$
$
$
Other
$
$
$
$
$
$
$
$
Total Value
__________________ (date) - Please provide total amount for each type of asset and who owns.
ASSET INFORMATION AS OF
TYPE OF ASSET
YOU
SPOUSE
JOINT
TOTAL
Cash, Checking, Savings, CD=s, Money Market & Cash Management Accounts
$
$
$
$
Investment/Broker-held Accounts (not including cash) and Mutual Fund Accounts
$
$
$
$
Retirement Accounts: IRA, 401K, 403B, SEP, etc.
$
$
$
$
Life Insurance: death benefit and cash value
D.B. $
D.B. $
D.B. $
D.B. $
C.V. $
C.V. $
C.V. $
C.V. $
Stocks: you hold (not in brokerage accounts)
$
$
$
$
Bonds: bonds you hold (not in brokerage accounts)
$
$
$
$
Annuities: $ = original amount invested date=month/year purchased
$ ______ date ____
$ ______ date ____
$ ______ date ____
$ ______ date ____
CV=current value
CV _____________
CV _____________
CV _____________
CV _____________
Real estate: residence (per tax bill)
$
$
$
$
Real estate: other
$
$
$
$
Vehicles: automobile, motorcycle, boats, snowmobiles, etc.
$
$
$
$
$
$
$
$
Total Value
Over Please
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Parent category: Business