Net Worth Statement

Securities and Advisory services offered through LPL Financial, A Registered Investment Advisor, Member FINRA/SIPC

Month & Year:

Checking, Savings, Money Market, CD accounts Mortgages (Home, Second Mortgage, Line of Credit,etc.)

Car loans, Credit Cards, Account Payable, etc.

Retirement (401(k), 403(b), TSP, 457, SEP, Simple, etc.)

Personal Retirement (IRA, Roth IRA,Rollover IRA, other) Other debts (unpaid taxes, etc.)

TOTAL LIABILITY:

Investments (Brokerage, Annuites, Savings Bonds, etc.)

TOTAL ASSETS:

TOTAL LIABILITY:

NET WORTH:

Real Estates and Other Assets

TOTAL ASSETS: TOTAL ANNUAL GROSS INCOME:

Annual Income Before Tax(Gross Annual Income):

Liabilities:Assets:

Client(s) Name:

(H) – Husband (W) – Wife Please list All your Accounts in detail: (Name of Account, Type of Account and Amount of Account)

Annual Income / Expense Sheet

Securities and Advisory services offered through LPL Financial, A Registered Investment Advisor, Member FINRA/SIPC

Annual Income Sources If married please add both incomeGross Employment Income (Total Annual Income before taxes and deductions)Other Annual Gross Income (Rental properties, pension payments, royalties, etc.)Pre Tax Deductions (401k, 403b, health insurance, etc.)Taxes: (Federal, Social Security, Medicare, State)

Net Annual Income After Tax

Regular Annual Expenses

Total Annual ExpensesTotal Annual Discretionary Income (Net Annual Income - Total Annual Expenses)

Client(s) Name: Month & Year: