Liabilities Questionnaire

Liabilities Questionnaire
Please complete the following form as best you can.
Note, all information submitted in this form is highly confidential.

If you have any questions, please feel free
to call: 913-543-3836 or email: contact@wallastreet.com
Name

First NameLast Name
Email
example@example.com
Primary Residence Mortgage Institution Name:
Primary Residence Loan Type:
Primary Residence Date of Loan:

MonthDayYear
Date
Primary Residence Original Loan Amount:
Primary Residence Current Balance:
Primary Residence Interest Rate:
Primary Residence Payment Frequency:

MonthlyQuartlerySemi-AnnuallyAnnually
Primary Residence Repayment Type:

Principal and InterestInterest Only
Primary Residence Payment Amount:
Primary Residence: Is the interest deductible?:

YesNo
Primary Residence: Insured for life?:

YesNo
Primary Residence: Paid off at death of:

ClientSpouseFirst to Die
Secondary Residence Mortgage Institution Name:
SecondaryResidence Loan Type:
Secondary Residence Date of Loan:

MonthDayYear
Date
Secondary Residence Original Loan Amount:
Secondary Residence Current Balance:
Secondary Residence Interest Rate:
Secondary Residence Payment Frequency:

MonthlyQuartlerySemi-AnnuallyAnnually
Secondary Residence Repayment Type:

Principal and InterestInterest Only
Secondary Residence Payment Amount:
Secondary Residence: Is the interest deductible?:

YesNo
Secondary Residence: Insured for life?:

YesNo
Secondary Residence: Paid off at death of:

ClientSpouseFirst to Die
Liabilities: Loans
Loan #1 Type:
(Business, Auto, Personal, LOC, Student Loan, Credit Card, etc.)
Loan #1 Institution Name:
Loan #1 Original Loan Amount:
Loan #1 Date of Loan:

MonthDayYear
Date
Loan #1 Current Balance:
Loan #1 Current Balance:

MonthDayYear
Date
Loan #1 Owner:
(Client, Spouse, Joint, Trust, etc.)
Loan #1 Interest Rate:
Loan #1 Number of Payments:
Loan #1 Payment Frequency:

MonthlyQuarterlySemi-AnnuallyAnnually
Loan #1 Payment Frequency:

Principal and InterestInterest Only
Loan #1 Payment Amount:
Loan #1 Annual Fee:
Loan #1 Balloon Period (years):
Loan #1 Interest Deductible?:

YesNo
Loan #1 Loan Collateralized?:

YesNo
Loan #1 Paid off at death of:

ClientSpouseFirst to Die
Loan #2 Type:
(Business, Auto, Personal, LOC, Student Loan, Credit Card, etc.)
Loan #2 Institution Name:
Loan #2 Original Loan Amount:
Loan #2 Date of Loan:

MonthDayYear
Date
Loan #2 Current Balance:
Loan #2 Current Balance:

MonthDayYear
Date
Loan #2 Owner:
(Client, Spouse, Joint, Trust, etc.)
Loan #2 Interest Rate:
Loan #2 Number of Payments:
Loan #2 Payment Frequency:

MonthlyQuarterlySemi-AnnuallyAnnually
Loan #2 Payment Frequency:

Principal and InterestInterest Only
Loan #2 Payment Amount:
Loan #2 Annual Fee:
Loan #2 Balloon Period (years):
Loan #2 Interest Deductible?:

YesNo
Loan #2 Loan Collateralized?:

YesNo
Loan #2 Paid off at death of:

ClientSpouseFirst to Die
Loan #3 Type:
(Business, Auto, Personal, LOC, Student Loan, Credit Card, etc.)
Loan #3 Institution Name:
Loan #3 Original Loan Amount:
Loan #3 Date of Loan:

MonthDayYear
Date
Loan #3 Current Balance:
Loan #3 Current Balance:

MonthDayYear
Date
Loan #3 Owner:
(Client, Spouse, Joint, Trust, etc.)
Loan #3 Interest Rate:
Loan #3 Number of Payments:
Loan #3 Payment Frequency:

MonthlyQuarterlySemi-AnnuallyAnnually
Loan #3 Payment Frequency:

Principal and InterestInterest Only
Loan #3 Payment Amount:
Loan #3 Annual Fee:
Loan #3 Balloon Period (years):
Loan #3 Interest Deductible?:

YesNo
Loan #3 Loan Collateralized?:

YesNo
Loan #3 Paid off at death of:

ClientSpouseFirst to Die
Loan #4 Type:
(Business, Auto, Personal, LOC, Student Loan, Credit Card, etc.)
Loan #4 Institution Name:
Loan #4 Original Loan Amount:
Loan #4 Date of Loan:

MonthDayYear
Date
Loan #4 Current Balance:
Loan #4 Current Balance:

MonthDayYear
Date
Loan #4 Owner:
(Client, Spouse, Joint, Trust, etc.)
Loan #4 Interest Rate:
Loan #4 Number of Payments:
Loan #4 Payment Frequency:

MonthlyQuarterlySemi-AnnuallyAnnually
Loan #4 Payment Frequency:

Principal and InterestInterest Only
Loan #4 Payment Amount:
Loan #4 Annual Fee:
Loan #4 Balloon Period (years):
Loan #4 Interest Deductible?:

YesNo
Loan #4 Loan Collateralized?:

YesNo
Loan #4 Paid off at death of:

ClientSpouseFirst to Die
Liabilities Additional Notes:
Should be Empty: