Financial & Tax Worksheet

For your Financial & Tax Worksheet, please fill out the form below. All information is confidential, in accordance with our privacy policy. The data in this form is sent securely using SSL protocol. If you would prefer to use a PDF version of this form, you may download and print a hard copy. For the PDF version, click here.

Financial & Tax Worksheet

Your name*

Email address*

Phone*

County of residence

Home address (Street address, City, State, Zip)

Husband's Information

Husband's legal name

Name husband usually uses to sign legal documents

Husband's date of birth

Husband's social security number

Husband's driver's license number

U.S. citizen?

Yes

Wife's Information

Wife's legal name

Name wife usually uses to sign legal documents

Wife's date of birth

Wife's social security number

Wife's driver's license number

U.S. citizen?

Yes

Date of marriage

Marriage status

Married

Divorced

Widowed

Single

Children and/or other family members

Use full legal names, complete addresses and dates of birth. (Use “JT” if both spouses are the parents, “H” if husband is the parent and “W” if the wife is the parent.)

Child's full legal name

Address

Date of birth

JT/H/W

Assets

Checking and Savings Accounts

Description

Current Value

Specifics

Total value

CD's and Money Market Accounts

Description

Current Value

Specifics

Total value

Stocks, Bonds and Mutual Funds

Description

Current Value

Specifics

Total value

Retirement Accounts

IRA, 401-K, TSA or other Accounts

Description

Current Value

Specifics

Life Insurance/Annuities

Description

Current Value

Specifics

Income Sources

Social Security:

Pensions:

Investments:

Rents:

Other:

Tax Notes

AGI:

C.G.'s:

Deductions:

Credits:

Other:

Additional Information:

Type the characters*

This field should be left blank

(855) 904-REAP

info@retirementestateplan.com