Planned Buy/Sell Transactions 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

Planned Buy #1: Name of Asset:

Planned Buy #1: Owner:

(Client, Spouse, Joint, Trust, LLC, Other)

Planned Buy #1: Transaction Occurs:

(Year, Client or Spouse Age, Client or Spouse Retirement, Client or Spouse Death, At First Death, Other)

Planned Buy #1: Type of Asset:

(Real Estate, Personal Property, Business, Other)

Planned Buy #1: Purchase Price:

Planned Buy #1: Transaction Costs:

Planned Buy #2: Name of Asset:

Planned Buy #2: Owner:

(Client, Spouse, Joint, Trust, LLC, Other)

Planned Buy #2: Transaction Occurs:

(Year, Client or Spouse Age, Client or Spouse Retirement, Client or Spouse Death, At First Death, Other)

Planned Buy #2: Type of Asset:

(Real Estate, Personal Property, Business, Other)

Planned Buy #2: Purchase Price:

Planned Buy #2: Transaction Costs:

Planned Sell #1: Name of Asset:

Planned Sell #1: Owner:

(Client, Spouse, Joint, Trust, LLC, Other)

Planned Sell #1: Transaction Occurs:

(Year, Client or Spouse Age, Client or Spouse Retirement, Client or Spouse Death, At First Death, Other)

Planned Sell #1: Type of Asset:

(Real Estate, Personal Property, Business, Other)

Planned Sell #1: Sales Price:

Planned Sell #1: Transaction Costs:

Planned Sell #1: Tax Basis:

Planned Sell #2: Name of Asset:

Planned Sell #2: Owner:

(Client, Spouse, Joint, Trust, LLC, Other)

Planned Sell #2: Transaction Occurs:

(Year, Client or Spouse Age, Client or Spouse Retirement, Client or Spouse Death, At First Death, Other)

Planned Sell #2: Type of Asset:

(Real Estate, Personal Property, Business, Other)

Planned Sell #2: Sales Price:

Planned Sell #2: Transaction Costs:

Planned Sell #2: Tax Basis:

Liability to Incur #1: Name of Liability:

Liability to Incur #1: Owner:

(Client, Spouse, Joint, Trust, LLC, Other)

Liability to Incur #1: Transaction Occurs:

(Year, Client or Spouse Age, Client or Spouse Retirement, Client or Spouse Death, At First Death, Other)

Liability to Incur #1: Underlying Asset:

(Real Estate, Personal Property, Business, Other)

Liability to Incur #1: Original Loan Amount:

Liability to Incur #1: Interest Rate:

Liability to Incur #1: Loan Term (years):

Liability to Incur #1: Payment Frequency:

(Monthly, Quarterly, Semi-Annually, Annually, Other)

Liability to Incur #1: Payment Amount:

Liability to Incur #2: Name of Liability:

Liability to Incur #2: Owner:

(Client, Spouse, Joint, Trust, LLC, Other)

Liability to Incur #2: Transaction Occurs:

(Year, Client or Spouse Age, Client or Spouse Retirement, Client or Spouse Death, At First Death, Other)

Liability to Incur #2: Underlying Asset:

(Real Estate, Personal Property, Business, Other)

Liability to Incur #2: Original Loan Amount:

Liability to Incur #2: Interest Rate:

Liability to Incur #2: Loan Term (years):

Liability to Incur #2: Payment Frequency:

(Monthly, Quarterly, Semi-Annually, Annually, Other)

Liability to Incur #2: Payment Amount:

Additional Notes: