First person First Name Last Name Sex Date of Birth Retirement Age Marital Status Home Phone Email Address City State ZIP Cell Phone Employer Business Phone Second person First Name Last Name Sex Date of Birth Retirement Age Marital Status Home Phone Email Address City State ZIP Cell Phone Employer Business Phone Will/Trust Type Last Updated Living Will / Health Care Proxy / Power of Attorney Other estate planning documents Income Salary – first person Person Annual Amount Salary – second person Person Annual Amount Self – employed income Person Annual Amount Alimony / Child support Person Annual Amount Social Security Person Annual Amount Investment Income Person Annual Amount Pension Income Person Annual Amount Expenses Housing (include property taxes) Monthly Amount Applicable Period Food (plus lunches) Monthly Amount Applicable Period Cars/Transportation/Gas Monthly Amount Applicable Period Entertainment Monthly Amount Applicable Period Medical/Dental/ Prescriptions Monthly Amount Applicable Period Discretionary Monthly Amount Applicable Period Personal Monthly Amount Applicable Period Charity Monthly Amount Applicable Period Other Monthly Amount Applicable Period Other Monthly Amount Applicable Period Debts Mortgage Owner Balance Interest Rate Term Auto Loan Owner Balance Interest Rate Term Credit Card Owner Balance Interest Rate Term Other Owner Balance Interest Rate Term Other Owner Balance Interest Rate Term Children / Dependents / Grandchildren Name Birth Date Relationship Name Birth Date Relationship Name Birth Date Relationship Name Birth Date Relationship Investments Liquid Assets Asset Owner Type Current Value Goal for Account Asset Owner Type Current Value Goal for Account Asset Owner Type Current Value Goal for Account Tax Deferred Assets Asset Owner Type Current Value Goal for Account Asset Owner Type Current Value Goal for Account Asset Owner Type Current Value Goal for Account Other Assets Asset Owner Type Current Value Goal for Account Asset Owner Type Current Value Goal for Account Insurance Owner Type Amount Cash Value (if applicable) Owner Type Amount Cash Value (if applicable) Owner Type Amount Cash Value (if applicable) Owner Type Amount Cash Value (if applicable) Other Assets Description Owner Estimated Value Mortgage (if applicable) Description Owner Estimated Value Mortgage (if applicable) Description Owner Estimated Value Mortgage (if applicable) Description Owner Estimated Value Mortgage (if applicable) Reason for Meeting Financial Goals Send
