Retirement Questionnaire - Hilliard Lyons

Retirement Questionnaire
Financial Consultant Branch
PERSONAL INFORMATION
First Name Middle Last ____________________________________
Birthdate (mm/dd/yyyy) Gender Male Female SSN ________________________________
Address__________________________________________________________________________________________________
________________________________________________________________________________________________________
City State Zip ______________________________
CO-CLIENT INFORMATION
First Name Middle Last ____________________________________
Birthdate (mm/dd/yyyy) Gender Male Female SSN ________________________________
DEFINE YOUR RETIREMENT GOAL
CLIENT CO-CLIENT
What is your current annual earned income?
What earned income growth rate do you expect on your
current income?
At what age do you plan to retire?
At what age do you expect your retirement to end? (Default age 90)
$ $
PRE-RETIREMENT POST-RETIREMENT
What average income tax rate* (state & federal) do you want to
assume?
*Figure this rate by dividing the total dollar amount of income taxes you
paid last year (state, federal and local as applicable) by your income.
What amount would you like to spend annually during retirement
(after-tax)?
$
Debt Obligations
DESCRIPTION INTEREST RATE CURRENT BALANCE MONTHLY PAYMENT AMOUNT
% $ $
% $ $
% $ $
% $ $
Hilliard Lyons does not offer tax or legal advice. Please consult your tax advisor or attorney before making any decision that may affect your tax or legal situation.
Securities offered by J.J.B. Hilliard, W.L. Lyons, LLC | Member NYSE, FINRA & SIPC. ©2011 All rights reserved.