General Information

Agent

Today's Date

Date Needed By

Client's Name

Client's Date of Birth

Spouse of Client

Spouse's Date of Birth

State

Dependents

Federal Income Tax-Rate

State Income Tax Rate

Taxable Income

Financial Account Overview

Fund Type

IRA
401(K)
TSP
403(B)
Non-qualified Funds
CV Life
Annuities
Savings
CD's
Roth

Tax Qualified? Annuities

Yes

No

Tax Qualified? Savings

Yes

No

Tax Qualified? CDs

Yes

No

Goal With Money

Income

$

Growth

Legacy

Filing Status (Check One)

Filing Status

Single

Head of Household

Married Filing Jointly

Married Filing Separately

Personal Income Information

Pension

Social Security #1

Social Security #2

AGI

Adjusted Gross Income

Additional Income

Emotional Considerations

Emotional Considerations

Taxes Going Up

Income Planning

Legacy Planning

Risk Tolerance

Risk Tolerance

Moderate

Considerate

Aggressive

NOTES/QUESTIONS

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