Occupation:

Occupation:

State:
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Work Phone:

Ages:

Are all Federal, State & Local tax returns up to date and filed on time?
Yes     No

Are any of your income tax filings on extension?
Yes     No

Do you and your spouse (if applicable) each have a will?
Yes     No

Do your will(s) have trust arrangements?
Yes     No

Do you and your spouse (if applicable) have a living trust?
Yes     No

Do you and your spouse (if applicable) have health proxies?
Yes     No

Do you and your spouse (if applicable) have durable power?
Yes     No

Which policies do you have? (check all that apply)
Homeowners     Disability     Life     Long Term Care     Umbrella

Retire comfortably
1     2     3    

Provide for children's education
1     2     3    

Save on income taxes
1     2     3    

Provide for survivors in the event of my death
1     2     3    

Structure my estate to minimize estate taxes
1     2     3    

Other (please explain)
1     2     3     Please Explain:

If retirement is one of your goals, at what age would you like to retire?

Your spouse? (If Applicable)

How important are the following investment objectives? Rank in order of importance (1 = most important, 3 = least)

Increase current income
1     2     3    

Spread risk among investments (i.e. diversity)
1     2     3    

Have cash available for emergencies or investment opportunities (i.e. liquidity)
1     2     3    

Accumulate funds that will keep pace with inflation or do better than inflation
1     2     3    

Use borrowed funds to increase return from my investments (i.e. leverage)
1     2     3    

Minimize the time I have to spend managing my investments
1     2     3

Strongly dislike risk, prefer very safe investments (i.e. insured savings, government securities, etc.)

Prefer little risk. I want to know how much my investment will pay (i.e. highly-rated bonds)

Willing to assume some risk (i.e. stocks, mutual funds, etc.)

Prefer greater risk (i.e. speculative stocks and other investments where the return is uncertain, but may be substantial)

Have you ever been unhappy with the recommendations of a stockbroker, insurance agent and/or any other financial advisor or consultant?
Yes     No
If Yes, Please Explain:

Do you expect any inheritances, legal settlements or gifts that may affect your financial plan?
Yes     No
If Yes, Please Explain:

How were your current investment assets selected? (Who devised where they where going to go and why):

Indicate which of the following statements summarize your attitudes or beliefs using a scale of 1-5.
(1 being most true and 5 least true)

I would rather work longer than reduce my standard of living in retirement.
1     2     3     4     5

I feel that I/we can reduce our current living expenses to save more for the future if needed.
1     2     3     4     5

I am more concerned about protecting my assets than about growth.
1     2     3     4     5

I prefer mutual funds to individual stocks and bonds.
1     2     3     4     5

I am comfortable with investments that promise slow, long term appreciation and growth.
1     2     3     4     5

I don't brood over bad investment decisions I've made.
1     2     3     4     5

I feel comfortable with aggressive growth investments.
1     2     3     4     5

I don't like surprises.
1     2     3     4     5

I am optimistic about my financial future.
1     2     3     4     5

My immediate concern is for income rather than growth opportunities.
1     2     3     4     5

I am a risk taker.
1     2     3     4     5

I make investment decisions comfortably and quickly.
1     2     3     4     5

I like predictability and routine in my daily life.
1     2     3     4     5

I usually pick the tried and true, the slow, safe but sure investments.
1     2     3     4     5

I need to focus my investment efforts on building cash reserves.
1     2     3     4     5

I prefer predictable, steady return on my investments, even if the return is low.
1     2     3     4     5

I am interested in providing for my children's education.
1     2     3     4     5