Cornerstone Financial Planning, LLC



Cornerstone Financial Planning, LLC

FINANCIAL PLANNING QUESTIONNAIRE FOR DIVORCE PLANNING

A. GENERAL INFORMATION

Today’s Date: _______________

How were you referred to us? __________________________

| |YOU |YOUR SPOUSE |

|Legal Name | | |

|Preferred Name | | |

|Date of Birth | | |

|Employer | | |

|Occupation | | |

|Work Phone | | |

|Work Email | | |

Your Current Address

Street: _______________________________________________________

City: _____________________ State: __________ Zip Code: ________

Home Phone: __________________ Home Email: _____________________

Date of marriage _____

Date of legal separation _____

B. CHILDREN

| |CHILD 1 |CHILD 2 |CHILD 3 |CHILD 4 |

|Name | | | | |

|Date of Birth | | | | |

|Health | | | | |

|Living with you? | | | | |

|Marital Status | | | | |

|College Planned | | | | |

|Grandchildren | | | | |

C. GENERAL PLANNING OBJECTIVES

Given your current situation, what are your objectives in working with a financial professional:

_________________________________________________________________

__________________________________________________________________

__________________________________________________________________

D. INCOME

Projected Income:

This Year Next Year How often are you paid?

You: ___________ __________ Weekly Biweekly Bimonthly Monthly

Your Spouse:___________ __________ Weekly Biweekly Bimonthly Monthly

Do you have plans to attend school or retrain to enter the work force:

____________________________________________________________________

____________________________________________________________________

Do you expect to receive an inheritance in the future? (when and how much)

____________________________________________________________________

E. HEALTH

Health Status:

What is your current health status? Please list any chronic medical conditions or other helpful information:

You: _______________________________________________

Your Spouse: _______________________________________________

F. ESTATE PLANNING

You Your Spouse

Year of execution (if created):

Wills __________ __________

Durable Power of Attorney __________ __________

Living Will __________ __________

Health Care Proxy __________ __________

Revocable Trusts __________ __________

G. INSURANCE

| |If Life Insurance, | | | |

|Type of Insurance (Life, |indicate if term or whole | | | |

|Disability, Long-Term Care) |life | |Who is the insured? |Group or private policy? |

| | |Amount | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

H. SMALL BUSINESS

Do you have an ownership interest in a small business? Please provide the following details:

Type of business: C Corp: ___ S Corp: ___ Partnership ___ Proprietorship ___

Nature of business: _______________________________________

Percent of ownership: ____%

What is the value of your interest? $________

Do you have a buy-sell agreement in place? _______

Do you use business credit cards for personal expenses? Circle any that apply:

Auto payment Landscaping Household supplies Utilities

Auto Insurance Travel Entertainment Meals

Auto Gas/Maint Country Club Telephone Cell Phone

Disability Insurance Life Insurance Health Insurance Internet

Other ___________________

I. TAXES

Are you aware of any income tax refunds you are owed?

Are you aware of any outstanding income tax liabilities?

J. EXPENSES

Extraordinary/Deferred expenses:

Describe any forthcoming obligations which have not been paid for yet:

____________________________________________________________________

____________________________________________________________________

Are you currently providing support to anyone other than minor or college age children?

____________________________________________________________________

____________________________________________________________________

PLEASE CONTINUE THE QUESTIONNAIRE ON THE NEXT PAGE

K. ASSETS AND LIABILITIES

|TYPE OF ACCOUNT |Ownership (Name) | Current Value |

|LIQUID ASSETS: | | |

|Checking Account | | |

|Savings Account | | |

|Money Market Account | | |

|Savings Bonds | | |

|Other | | |

|Total Liquid Assets: | | |

| | | |

|INVESTED ASSETS: | | |

|Direct Ownership | | |

|Brokerage Account | | |

|Mutual Fund Account | | |

|Other | | |

|Total Invested Assets: | | |

| | | |

|TAX-DEFERRED ASSETS: | | |

|IRA | | |

|IRA | | |

|Roth IRA | | |

|Roth IRA | | |

|Company Retirement Plan | | |

|Company Retirement Plan | | |

|Annuity | | |

|Annuity | | |

|Other | | |

|Other | | |

|Total Tax-Deferred Assets: | | |

| | | |

|PERSONAL ASSETS: | | |

|Personal Residence | | |

| Year purchased: Cost basis: |

|Second Home | | |

| Year purchased: Cost basis: |

|Personal Prop. & Furniture | | |

|Artwork/Collectibles | | |

|Auto | | |

|Auto | | |

|Boat | | |

|Other | | |

|Total Personal Assets: | | |

|TOTAL ASSETS: | | |

ASSETS AND LIABILITIES CONTINUED:

|LIABILITIES: |Ownership (Name) | Current Value |

|Mortgage | | |

|Home Equity Line | | |

|Credit Card | | |

|Credit Card | | |

|Student Loan | | |

|Auto Loan | | |

|Other | | |

|Other | | |

|Total Liabilities: | | |

| | | |

|NET WORTH: | | |

L. MISCELLANEOUS ASSETS

Do you have a safe deposit box: Yes No

Contents of value:________________________________

Do you have a safe: Yes No

Contents of value:________________________________

Do you have a rewards program Yes No

Value: __________________________________

Do you own company stock options? Yes No Company Name: _________________

Please provide a current Option Summary Statement

Thank you for completing this questionnaire.

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