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Financial WorkbookPrepared for:Brought to you by:Table of ContentsBudget OrganizerBalance SheetPage2-45Bank and Brokerage AccountInventory 6Retirement Plan Inventory7Life Insurance Inventory:Permanent Insurance8Life Insurance Inventory: TermInsurance 9Professional AdvisorsDocument Checklist1011 - 12Disposition of Personal Property13Business Disposition14Funeral Instructions15 - 16Important Information17
Budget OrganizerIncomeMonthlyAmountIncome:Salary and BonusesInterest/Investment IncomeOther IncomeAnnualAmount 0000 0Income Sub-TotalIncome Taxes:Federal Income TaxesState Income TaxesFICA/Self-Employment Taxes000Income Taxes Sub-TotalAvailable Income00 00 Fixed Expenses - PersonalMonthlyAmountHousing:Mortgage/Rent PaymentProperty TaxesHomeowners/Renters InsuranceAnnualAmount 000Transportation:Car PaymentAutomobile InsuranceParking/Tolls/Bus/Train000Loans:Credit Card PaymentsPersonal Loan/Student Loan Payments00Insurance:Life Insurance PremiumsDisability Income Insurance PremiumsHealth Insurance PremiumsDental/Vision Insurance Premiums0000Personal/Family:Child Support/Child Care Expenses/AlimonyMembership/Professional Dues00Savings/Investments:Emergency FundPersonal Savings/InvestmentsRetirement Savings (401(k) or IRA)000Other Fixed Expenses:0Total Fixed ExpensesFinancial Workbook 0 0Page 2 of 17
Budget OrganizerVariable Expenses - PersonalMonthlyAmountHousing:Utilities (electricity, gas, water)Telephone/InternetHome Repair/MaintenanceHousehold Goods/FurnishingsTransportation:FuelAuto Family:Food/Personal Care ItemsClothingLaundry/Dry CleaningDoctor/Dental/Prescription Drug ExpensesGifts/Charitable ContributionsEntertainment:Cable/Satellite TVDining OutMovies/Sporting EventsBabysitterHobbiesVacation/TravelOther Variable Expenses:Total Variable ExpensesAnnualAmount 0000 000000000000000000 0 Total Personal ExpensesMonthlyAmountTotal Fixed ExpensesTotal Variable ExpensesTotal Personal ExpensesFinancial WorkbookAnnualAmount 00 00 0 0Page 3 of 17
Budget OrganizerFixed and Variable Expenses - BusinessMonthlyAmountRent/Mortgage PaymentSalariesTaxesEmployee Fuel ExpensesTravelTax/Accounting/Banking PostageBusiness EntertainmentProfessional/Association DuesOther Business Expenses:AnnualAmount Total Business Expenses0000000000000 0 0000 Balance SheetMonthlyAmountAvailable IncomeTotal Personal ExpensesTotal Business ExpensesSurplus/ShortageFinancial Workbook AnnualAmount0000 0000Page 4 of 17
Balance SheetAssetsMarket Value(Spouse 1/Partner 1) 0 Checking AccountsSavings AccountsCDsU.S. Savings BondsMutual FundsStocks/BondsLimited PartnershipsResidence(s)Investment Real EstateLife Insurance Cash ValuesAnnuitiesIRAsQualified Retirement Plans (vested)Business InterestsCollectiblesAutomobilesPersonal PropertyOther:TOTALMarket Value(Spouse 2/Partner 2) 0 MarketValue(Joint) 0 0 TOTAL ASSETSLiabilitiesMortgage(s)Other Real Estate LoansHome Equity LoansAuto LoansEducation LoansInstallment LoansCharge AccountsCredit CardsPersonal Credit LineBusiness DebtOther:TOTAL LIABILITIESMonthly Payment Balance 0 0 Balance SheetTotal AssetsTotal LiabilitiesNET WORTHFinancial Workbook0 0-0 Page 5 of 17
Bank and Brokerage Account InventoryBank AccountsBank 1Bank 2Name of BankAddressTelephone NumberAccount NumberBank OfficerAverage Balance Type of Account (Checking,Money Market, Savings)Ownership of Account(Individual, Joint, Joint andSurvivorship)Brokerage AccountsBrokerage 1Brokerage 2Firm NameAddressTelephone NumberAccount NumberBrokerValue as ofType of Account (Personal,Retirement, Trust)Ownership of Account(Individual, Joint, Trust)Financial WorkbookPage 6 of 17
Retirement Plan InventoryEmployer-Sponsored Retirement PlansPlan 1Plan 2CompanyPlan Type (Defined Benefit,Money Purchase, ProfitSharing, 401(k), SEPP, TDA,Deferred Compensation)Value as of Account NumberBenefits ManagerTelephone NumberPayout ProvisionsLump Sum or Annuity:Lump Sum or Annuity:Life OnlyLife OnlyLife Years CertainLife Years CertainJoint and % SurvivorJoint and % SurvivorPersonal Retirement PlansPlan 1Plan 2Bank or BrokeragePlan Type (Regular IRA,Roth IRA, Keogh, PersonalNon-Qualified Savings)Value as of Account NumberBank Officer or BrokerTelephone NumberPayout ProvisionsFinancial WorkbookLump Sum or Annuity:Lump Sum or Annuity:Life OnlyLife OnlyLife Years CertainLife Years CertainJoint and % SurvivorJoint and % SurvivorPage 7 of 17
Life Insurance Inventory: Permanent InsurancePermanent InsurancePolicy 1Policy 2CompanyPolicy NumberAgent/BrokerTelephone NumberType (WL, VL, UL, VUL)Death Benefit Premium Cash Value as of Outstanding Loan Policy OwnerBeneficiary(ies)Location of PolicyPolicy 3Policy 4CompanyPolicy NumberAgent/BrokerTelephone NumberType (WL, VL, UL, VUL)Death Benefit Premium Cash Value as of Outstanding Loan Policy OwnerBeneficiary(ies)Location of PolicyFinancial WorkbookPage 8 of 17
Life Insurance Inventory: Term InsuranceTerm InsurancePolicy 1Policy 2CompanyPolicy NumberAgent/BrokerTelephone NumberType (LT, DC, Group Term)Death Benefit Premium Policy OwnerBeneficiary(ies)Location of PolicyPolicy 3Policy 4CompanyPolicy NumberAgent/BrokerTelephone NumberType (LT, DC, Group Term)Death Benefit Premium Policy OwnerBeneficiary(ies)Location of PolicyFinancial WorkbookPage 9 of 17
Professional AdvisorsAttorney:Firm Name:Phone:Street Address:City, State, Zip:Accountant:Firm Name:Street Address:City, State, Zip:Life Insurance Agent:Firm Name:Phone:Phone:Street Address:City, State, Zip:P&C Insurance Agent:Firm Name:Phone:Street Address:City, State, Zip:Stockbroker:Firm Name:Phone:Street Address:City, State, Zip:Financial Planner:Firm Name:Phone:Street Address:City, State, Zip:Trust Officer:Firm Name:Phone:Street Address:City, State, Zip:Financial WorkbookPage 10 of 17
Document ChecklistDocumentLocationPersonal:Birth CertificateMarriage LicensePre- or Post-Nuptial AgreementWillTrust(s)Living Will(s)/Power(s) of AttorneyMortgage PapersAutomobile Titles/PapersIncome Tax ReturnsGift Tax ReturnsInsurance PoliciesEmployee Benefit DocumentsPassportMilitary RecordsMedical RecordsCitizenship PapersWarrantiesCurrent BillsFuneral/Burial DocumentsOther:Business Ownership:Partnership/Incorporation DocumentsBuy-Sell AgreementSection 303 Stock Redemption AgreementBusiness Valuation/AppraisalBusiness Tax ReturnsOther:Financial WorkbookPage 11 of 17
Document ChecklistIt is recommended that you keep the following documents in a secure location in your home: Copies of wills and trustsCopies of living wills and powers of attorneyIncome tax returnsThese documents are best kept in a bank safety deposit box: Original wills, trusts and powers of attorneyMarriage certificates, birth certificates, divorce decrees, death certificatesDeeds and car titlesMilitary discharge papersAny stock or bond certificatesCitizenship papersInsurance policiesConsider giving these items to your attorney, executor and/or spouse: Living will/medical power of attorney (original should be given to the agent named in thedocument)Copies of wills, trust agreements, powers of attorneyInventory of insurance and investmentsList of professional advisors (attorney, accountant, insurance agent, etc.)Safety deposit box access informationFuneral instructionsFinancial WorkbookPage 12 of 17
Disposition of Personal PropertyDescription of Personal PropertyRecipient of Personal PropertyNotes:Financial WorkbookPage 13 of 17
Business DispositionIn the event of your death, do you want your business interest:A. Retained for FamilyA.B. SoldC. LiquidatedFamily Retention:How is your busi ness interest to betransferred?by will (at death)by gift (during life)by sale (during life or at death)Who is to receive your business interest?B.Sold:To whom will your business interest be sold?Do you have a wriagreement?tten buy-sel lYesNoIf yes, where is the agreement kept?If yes, is the pl an funded wi th lifeinsurance?YesNoIf yes, where are the policies kept?C.Liquidated:Have you made provisio ns to avoid aforced liquidation?YesNoIf yes, what plans have been made?Financial WorkbookPage 14 of 17
Funeral Instructions for:Funeral HomeTelephone NumberPre-Planned Arrangement?YesNoBurial or pe of Casket/UrnOpen or Closed Casket?Appearance (clothing, jewelry)Special RequestsFuneral/Memorial Service?FuneralMemorialWhere?Who Should Preside at the Service?PallbearersRequested Hymns/ScripturesSpecial RequestsPlace of IntermentLocation of Cemetery Deed or ContractType of HeadstoneEpitaphSpecial RequestsObituary Notice?Donations in Lieu of Flowers?YesYesNoNoTo:Special RequestsOther InstructionsFinancial WorkbookPage 15 of 17
Funeral Instructions for:Funeral HomeTelephone NumberPre-Planned Arrangement?YesNoBurial or pe of Casket/UrnOpen or Closed Casket?Appearance (clothing, jewelry)Special RequestsFuneral/Memorial Service?FuneralMemorialWhere?Who Should Preside at the Service?PallbearersRequested Hymns/ScripturesSpecial RequestsPlace of IntermentLocation of Cemetery Deed or ContractType of HeadstoneEpitaphSpecial RequestsObituary Notice?Donations in Lieu of Flowers?YesYesNoNoTo:Special RequestsOther InstructionsFinancial WorkbookPage 16 of 17
Important InformationThe in formation, g eneral principles a nd c onclusions p resented in t his r eport a re s ubject to lo cal,state and fe deral l aws a nd regul ations, court case s and any re visions of sa me. Whil e every car ehas been ta ken i n the preparati on of thi s report, V SA, L. P. is not engag ed i n provi ding l egal,accounting, financial or ot her professional services. This report s hould not be used as a substitutefor the professional advice of an attorney, accountant, or other qualified professional.U.S. Treasury Circular 230 may requi re us to advi se you that "any tax information provided in thisdocument i s not i ntended or wri tten to be us ed, and cannot be use d, by any taxpayer for thepurpose of a voiding pena lties that may be i mposed on the tax payer. The tax i nformation waswritten to support the pr omotion or marketing of the transact ion(s) or matter(s) a ddressed an dyou should seek advice based on your particular circumstances from an independent tax advisor." VSA, LPAll rights reserved (VSA CW-11 ed. 01-21)Financial WorkbookPage 17 of 17
Retirement Plan Inventory 7 . Life Insurance Inventory: Permanent Insurance 8 . Life Insurance Inventory: Term Insurance 9 . Professional Advisors 10 . Document Checklist 11 - 12 . Disposition of Personal Property 13 . Business Disposition 14 . Funeral Instructions 15 - 16 . Important Information 17
