Asset form used at Althoff Law

Asset Inventory Worksheet

ALTHOFF LAW - LLC
713 Sandpiper Point
Fort Collins, Colorado 80525
970/223-5913
margaret @ althoff-law.com [remove spaces]

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 General Information

Name		Social Security No.	Date of Birth		Citizenship
Spouse’s Name		Social Security No.	Date of Birth		Citizenship
Home Address
City	State	Zip Code		Telephone Number
Business Address
City	State	Zip Code		Telephone Number
E-Mail

Should correspondence be sent to home or business?

CHildren/Grandchildren	Date of Birth	Handicapped/Incapacitated?

? Assets and Liabilities

	Fair Market Value and Ownership
assets	Single	Husband	Wife	Joint[1]
Residence	$	$	$	$
Non-Income Real Estate	$	$	$	$
Income Real Estate	$	$	$	$
Other Real Estate	$	$	$	$
Cash and Savings	$	$	$	$
Money Market/CDs	$	$	$	$
Taxable Bonds	$	$	$	$
Tax-Exempt Bonds	$	$	$	$
Equities	$	$	$	$
Mutual Funds	$	$	$	$
Annuities	$	$	$	$
Options	$	$	$	$
Futures, Commodities	$	$	$	$
Personal Property (Art, Antiques, Etc.)	$	$	$	$
Retirement Plans	$	$	$	$
Business Interests	$	$	$	$
Life Insurance (Face)	$	$	$	$
Spouse’s Life Insurance (Face)	$	$	$	$
Other	$	$	$	$
Total Assets	$	$	$	$

[1] If owned with a person other than spouse, state with whom title is held

Liabilities	Single	Husband	Wife	Joint
Loans	$	$	$	$
Mortgages	$	$	$	$
Margin Debt	$	$	$	$
Other	$	$	$	$
Total Liabilities	$	$	$	$

	Single	Husband	Wife	Joint
Total net Worth (total assets - total liabilities)	$	$	$	$

? Income and Retirement Plans

Annual Salary ($)	Spouse’s Annual Salary ($)
Other Income ($)	Spouse’s Other Income ($)

When do you plan to retire (age and year?)________________________________

How much after-tax spendable income do you expect to need at retirement?_______________

How much annual income would your family need in the event of your death?________________

Employee Benefits	Estimated Value	Name of Participant	Pre-Retirement Death Beneficiary	Amount of Life Insurance Included
Pension/Defined Benefit Plan/ Money Purchase	$
Profit Sharing Plan [401(k)]	$
Stock Purchase Plan	$
Stock Options (unexercised)	$
IRA	$
Keogh	$
Other	$
Total Value	$

? Estate Planning Information & Objectives

Have you drafted a will?________________ If so, when (year)?__________ Where (state)?___________

Has your spouse drafted a will?__________ If so, when (year)?___________ Where (state)?__________

Do you and/or your spouse have any living trusts?_______ If so, when were they drafted (years)?______

What property is in the trust?_____________________________________________________________

Do you have a power of attorney?___________ If so, date of document.__________________________

Do you have a medical power of attorney?______________ If so, date of document._________________

Have you ever lived in one of the following states: Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington and/or Wisconsin?

NOTE: If you indicated above that you and/or your spouse have a will and/or a living trust(s), please attach copies.

What are your financial goals? (Please check which objective is most applicable. If more than one applies, please number in order of importance - (l) being most important and (5) being least important.

______ To have adequate funds to cover both living expenses and future needs.

______ To reduce taxes by taking advantage of current tax laws.

______ To provide for retirement.

______ To provide income/assets for survivors in the event of death.

______ To provide for educational costs for children/grandchildren.

PRIVACY NOTICE

Notices concerning a company’s privacy policies and practices are mandated by the Gramm-Leach-Bliley Act, Pub. Law 106-102 November 12, 1999 and the correlative FTC regulation, 16 CFR Part 313 (May 24, 2000). The FTC has taken the position that lawyers and law firms that undertake certain types of representation, such as estate planning and tax planning, are also required to comply with the notice provisions of the regulation. Therefore, I am providing you with the firm's policies regarding privacy of client information.

In the course of providing you with income tax, estate tax, and gift tax advice, the firm receives significant personal financial information from you, the client. If you are a client of Margaret A. Althoff, LLC, you should know that all information that you provide to the firm is held in confidence, and is not released to people outside the firm, except as agreed to by you, or as required under an applicable law.

The firm retains records relating to professional services that it provides so that it is better able to assist you with your professional needs and in, some cases, to comply with professional guidelines. In order to guard your nonpublic personal information, the firm maintains physical, electronic, and procedural safeguards that comply with its professional standards.

As you are probably aware, attorneys, are bound by professional standards of confidentiality that are even more stringent than those required by this new law. Therefore, the firm will protect your right to privacy.

If you have any questions regarding the firm's policies regarding privacy of client information, please do not hesitate to call me, Margaret Althoff -- 970-223-5913.

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