Financial Planning Worksheet
CONFIDENTIAL
Name
*
First Name
Last Name
Mobile Phone Number:
*
Please enter a valid phone number.
Email
*
example@example.com
Monthly Budget
Housing
Amount
Mortgage/Rent
Second Mortgage/Rent
Condo/Association Fees
Insurance
Taxes
Electricity/Gas
Water/Sewer
Waste Removal
Maintenance/Repairs
Lawn Care
Phone/Cell Phone
Internet
Cable/Satellite
Other
*If other, please explain
Food & Entertainment
Current
Groceries
Dining Out
Movies/Concerts
Travel
Hobbies
Membership Dues
Other
*If other, please explain
Transportation
Current
Car Payment 1
Car Payment 2
Auto Insurance
Gas
Parking
Bus/Taxi Fare
Maintenance/Repairs
Licensing/Tags
Other
*If other, please explain
Personal
Current
Clothing
Personal Care
Child Care
Elder Care
Pet Care
Professional Fees (legal/tax)
Alimony
Child Support
Other*
*If other, please explain
Healthcare & Insurance
Current
Medical Services
Dental Services
Prescription & Medications
Health Insurance
Long-Term Care Insurance
Life Insurance
Other
*If other, please explain
Gifts & Donations
Current
Holiday Gifts
Birthdays
Charity
Church
*If other, please explain
Savings
Current
Taxable
Tax-Deferred
Tax-Exempt
Other
*If other, please explain
Sources of Income
Current
Salary
Social Security
Pension
Other
*If other, please explain
Assets/Liability (Personal property, businesses, debt)
What you own
Account Location
Value
Owed
Home
Personal Property
Business
Toys
Other assets
Student Loans
Credit Card
Personal Loans
Business Loans
Other Liability
*If other, please explain
Account Summary (Bank Accounts, Annuities, Life Insurance Policies)
Account Name/Owner/Number
Market (Benefit) Value
Bank Accounts
1
2
3
4
Annuities/Life Insurance
1
2
3
4
Please upload statements from investment accounts and insurance policies.
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All information is strictly confidential. Securities offered through Avantax Investment Services℠, Member FINRA,SIPC. Advisory services offered through Avantax Advisory Services℠, 400 S Jackson St. Jackson, MI 49201.
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