On this page, all dollar values should be estimated yearly values.
Your last name
Your first name
Partner's last name
Partner's first name
Employer
Employer address
Business phone
Number of years with this employer
Your title or position
Previous employer
Years w/prev. employer
Your date of birth
Name and phone no. of your accountant
Name and phone no. of your attorney
Name and phone no. of your investment advisor
Name and phone no. of your insurance advisor
The following questions refer to your financial partner.
Partner's employer
Partner's employer's address
Business phone
Years w/this employer
Title or position
Previous employer
Years w/prev. employer
date of birth
Partner's accountant, name and address
Partner's attorney, name and address
Partner's investor, name and address
Partner's insurance advisor, name and address
The following fields require financial data, which should be entered as a yearly total, and in the form "4500" rather than $4,500.00
Your gross salary or wages
Partner's gross salary
Your bonuses and commissions
Partner's bonuses
Income from rental units
Interest income
Dividend income
Capital gains
Partnership income
Other investment income
Describe other income source(s)
Other income
Yearly federal income and other taxes
Yearly State income and ohter taxes
Rental payments, if any
Mortgage payments, if any
Yearly property taxes
Principal and interest payments on loans other than your mortgage(s)
Insurance (homeowner, car, other)
Yearly investments
Alimony/child support you pay out
Tuition payments, self and children
Describe any other expenses besides regular living expenses. Regulary expenses are entered on page 2 of this financial statement
Other expenses