V. Assets A. Summary Statement (if necessary, attach a separate sheet) Asset C: Client Financial Institution(s) Amount S: Spouse/Other (or Cash Value for J; Joint Life Insurance) T: Trust Checking/Savings type c, s, j, or t financial institution(s) amount Brokerage Accounts type c, s, j, or t financial institution(s) amount Individual Stocks and type c, s, j, or t financial institution(s) amount Retirement type c, s, j, or t financial institution(s) amount Account(s) life insurance type c, s, j, or t financial institution(s) amount Annuities Non- type c, s, j, or t financial institution(s) amount – Qualified Annuities type c, s, j, or t financial institution(s) amount – B. Property Ownership (Provide Copies of Deeds/Stock Certificates) Owner(s) Address Type (e.g., house, Fair Mortgage Cost Basis condo, co-op) Market Balance Value full names of owners street address type fmv mortgage cost city, zip balance country full names of owners street address type fmv mortgage cost city, state zip balance basis country full names of owners street address type fmv mortgage cost city, state zip balance basis country full of owners street address type fmv mortgage cost city, state zip balance basis country VI. Income A. Summary Statement
V. Assets A. Summary Statement (if necessary, attach a separate sheet) Asset C: Client S: Spouse/Other J; Joint T: Trust Financial Institution(s) Amount (or Cash Value for Life Insurance) Checking/Savings type c, s, j, or t financial institution(s) amount Brokerage Accounts type c, s, j, or t financial institution(s) amount Individual Stocks and type c, s, j, or t financial institution(s) amount Retirement Account(s) type c, s, j, or t financial institution(s) amount life insurance type c, s, j, or t financial institution(s) amount Annuities – type c, s, j, or t financial institution(s) amount Annuities – Qualified type c, s, j, or t financial institution(s) amount B. Property Ownership (Provide Copies of Deeds/Stock Certificates) Owner(s) Address Type (e.g., house, condo, co-op) Fair Market Value Mortgage Balance Cost Basis full names of owners street address city, zip country type fmv mortgage balance cost full names of owners street address city, state zip country type fmv mortgage balance cost basis full names of owners street address city, state zip country type fmv mortgage balance cost basis full of owners street address city, state zip country type fmv mortgage balance cost basis VI. Income A. Summary Statement Non-
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