Retirement Questionnaire - Hilliard Lyons

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RETIREMENT ASSETS (provide the requested information about your retirement assets (401k, IRA, Roth IRA, Profit Sharing, etc.) QUALIFIED RETIREMENT ASSETS (401K, IRA, OTHER) Description Owner ASSET 1 ASSET 2 ASSET 3 ASSET 4 Client Co-Client Client Co-Client Client Co-Client Current Balance $ $ $ $ Annual Contribution (Employee) $ $ $ $ Annual Contribution (Employer) Annual Rate of Return $ $ $ $ Client Co-Client OTHER ASSETS (provide the requested information about other assets you own that would be available for retirement.) CASH ASSETS Description ASSET 1 ASSET 2 ASSET 3 ASSET 4 Current Balance $ $ $ $ Percent available for retirement % % % % Annual Contribution INVESTMENT ASSETS Description $ $ $ $ Current Balance $ $ $ $ Cost Basis $ $ $ $ Percent available for retirement % % % % Annual Contribution $ $ $ $ Rate of Return BUSINESS/REAL ESTATE/RENTAL/PERSONAL ASSETS Description % % % % Current Value $ $ $ $ Cost Basis $ $ $ $ Percent available for retirement % % % % Rate of Return % % % % 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.
INCOME SOURCES (Social Security, Pension, and Other Income Sources) CLIENT CO-CLIENT Are you covered by Social Security? Yes No Yes No At what age do you want your benefits to begin? What do you expect your annual Social Security benefit amount to be? What do you expect your annual pension amount to be? $ $ PENSION- CLIENT PENSION - CO-CLIENT $ Start Age Start Age What do you expect your annual pension amount to be? Survivor Benefit % Survivor Benefit % OTHER INCOME DURING RETIREMENT SOURCE 1 SOURCE 2 SOURCE 3 Description Annual Income $ $ $ Years until income begins Years income continues Rate income increases annually % % % Percent Taxable % % % NOTES/GOALS ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ $
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