FINANCIAL INFORMATION CHECK LIST o Real estate information: Address, purchase price and date purchased (Final HUD settlement form) Copies of Final HUD
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1 Client Data Organizer Celia Griffin, CPA, CDFA Celia Griffin, CPA, PLLC North Creek Parkway, Suite 120, Bothell, WA Phone (425) Fax (425) of 22
2 FINANCIAL INFORMATION CHECK LIST o Real estate information: Address, purchase price and date purchased (Final HUD settlement form) Copies of Final HUD settlement statement from most recent refinance Approximate dollar amount spent on capital improvements since purchased Current mortgage balance and copy of current mortgage statement Line of Credit statement and or second mortgage information, if applicable Copy of any recent appraisals Was gain from prior home owned and sold prior to 1998 rolled into current home? If so, please provide a copy of IRS Form 2119 from your federal income tax return filed the year you sold the prior home. o Most recent full monthly or quarterly statements for all bank or credit union savings and checking accounts o All current stock brokerage account full statements (showing cost basis), and any investments you may have (e.g., stock certificates, mutual funds, bonds, limited partnerships, etc.). o Information on loans payable to/from you from third parties, such as family members or friends o Copies of any life or disability insurance statements on each spouse; just the most recent statement detailing the type of policy, benefits, cash value (if applicable), owner & insured and monthly/annual premium amount). o Copies of full statements for children s college savings plans or UGMA accounts, or any bank accounts that either of the parents are signor s on. o Most recent statements for all retirement accounts, including 401(k), 403(b)s, IRAs, pensions, etc. o Copy of the most resent Social Security earnings & benefits statement for each. If you don t have a current statement, you can create an account and print one from: o Award letters and detailed vesting schedules for stock options, restricted stock units, employee stock purchases plans, or other types of employee equity compensation plans. Please provide shareholder agreements for stock held in non-public companies. o Registration statements for cars, recreational vehicles, trucks or boats as well as a description of their features and equipment for private party blue book value. Please go to the following website: type in the information for each automobile and print out the private party value with condition noted. Include it along with the most recent 2 of 22
3 registration renewal (in glove box) to verify make, model and year and registered owner: o List of valuable personal property such as family heirlooms, art, musical instruments, antiques, collections, memberships, season tickets for sports, theatrical or other events, etc. No need to provide values preliminarily. Let us know if you think you will be able to equitably divide personal property, or if you think a discussion would be helpful. o List and printouts of accrued airline miles and other affinity points o List of contents in safety deposit box o Information on any prepaid cemetery plots and burial arrangements o If you own a business, the most recent 2 income tax returns, annual profit and loss statements, and most recent balance sheet and current year-todate profit and loss statements, and any shareholder or partnership agreements. o Most recent full credit card statements for all cards, even if there is no recent activity o Documents showing amount due, interest rates and payments for loans, such as car loans, school loans, or personal loans made from third parties o Copies of W-2 statements filed with each years tax return as well as the year end pay stub for the prior 3 years o Most recent three pay stubs for both spouses that show deductions from gross pay and year to date income and withholdings o Federal individual tax returns for the past three years, and all supporting tax documents for the most recent year filed. o Detailed credit report for each spouse from one of the 3 credit bureaus. Available at free. No score is needed. o If you have minor children... Health Care Premium Fact Sheet showing employee cost to cover family members. o A copy of any community, separate property or pre-nuptial agreements Celia Griffin, CPA, CDFA Celia Griffin, CPA, PLLC North Creek Parkway, Suite 120, Bothell, WA Phone (425) Fax (425) celia@celiagriffincpa.com 3 of 22
4 Family Information Sheet WIFE'S BACKGROUND INFORMATION: Name (First, Middle, Last): Date of Birth: Date of Marriage: Date Separated: Address: City, State Zip:, Phone: Cell Phone: HUSBAND'S BACKGROUND INFORMATION: Name (First, Middle, Last): Date of Birth: Address: City, State Zip:, Phone: Cell Phone: CHILDREN Custody Exemption Husband or Husband or Child's Name Date of Birth Wife (H/W) Wife (H/W) 4 of 22
5 Assets and Liabilities 1. INVESTMENTS, CHECKING ACCOUNTS, ETC: Current Original Annual Title* Description Value Cost Income Type* (H/W/J) * Title (H-Husband, W-Wife, J-Joint) * Type (1-Cash, 2-Checking, 3-Money Market, 4-Savings, 5-Credit Union, 6-Brokerage Acct, 7-Escrow Acct, 8-CD, 9-US Savings Bonds, 10-Stock, 11-Bond, 12-Stock Fund, 13-Mutual Fund, 14-Bond Fund, 15-Real Estate) 5 of 22
6 Assets and Liabilities (cont.) 2. DEBTS: Current Interest Monthly Description Balance Rate (%) Payment 3. PERSONAL ITEMS: Current Original Title* Description Value Cost (M/H/W) Type* 6 of 22
7 Assets and Liabilities (cont.) * Title (H-Husband, W-Wife, J-Joint) * Type (1-Household, 2-Furniture, 3-Art, 4-Jewlery, 5-Paintings, 6-Prints, 7-Antiques, 8-Precious Object, 9-Gold or Metals, 10-Collections, 11-Tradmarks, 12-Patents, 13-Other) 4. VEHICLES: Current Original Title* Description Make/Model/Year Value Cost Type* (H/W/J) * Title (H-Husband, W-Wife, J-Joint)* Type(1-Car, 2-Truck, 3-RV, 4-Boat, 5-Plane)* Title (H-Husband, W-Wife, J-Joint) 7 of 22
8 Assets and Liabilities (cont.) 5. REAL ESTATE: Basic Info: 1st Property 2nd Property 3rd Property Address: Current Value: Original Cost: Title (H, W, J)*: 1st Mortgage: Balance: Interest Rate (%): Monthly Payment*: Statement Month/Year: Who will pay (H/W/Both): 2nd Mortgage: Balance: Interest Rate (%): Monthly Payment*: Statement Month/Year: Who will pay (H/W/Both): * For monthly payment include interest & principal only, do NOT include taxes or insurance. * Title (H-Husband, W-Wife, J-Joint) 8 of 22
9 Assets and Liabilities (cont.) 6. IRA / 401k ACCOUNTS: Current Title* Description Value (H/W) * Title (H-Husband, W-Wife) 7. LIFE INSURANCE: Amount of Amount of Premium Premium Cash Paid By Paid By Title* Description Value Husband Wife (H/W) * Title (H-Husband, W-Wife) 9 of 22
10 Assets and Liabilities (cont.) 8. BUSINESS: Annual Form of Current Original Cash Business Title* Description Value Cost Flow (I/P/C)* (H/W) * Title (H-Husband, W-Wife, J-Joint) * Form of Business (I-Individual, P-Partnership or S Corporation, C-C Corporation) 10 of 22
11 Income and Expenses WAGES FOR HUSBAND Annual wage and salary income, before taxes: NON-WAGE INCOME FOR HUSBAND Use this sheet to specify income that is not covered on any other sheet. Specify an amount in whichever column (Week, Month, or Year) is most convenient. Child support from previous relationship Alimony from previous relationship Unemployment Compensation Public Assistance Bonuses Commissions Tips Overtime Disability Insurance Workers' Compensation Royalties Rent from Spouse Deferred Compensation of 22
12 Income and Expenses (cont.) Detailed Expenses for Husband: On this data sheet, specify the household, child, and personal expenses of everyday life. The list tries to be comprehensive, but there is no need to fill in every line. Mandatory Deductions Mandatory Retirement Union Dues Other Mandatory Household Rent Condo Fee Homeowners' Insurance Renters' Insurance Real Estate Tax Cable TV Internet Access Phone Household Maintenance Furniture & Appliance Painting/Wallpapering Household Supplies Maid/Cleaning Service Lawn Service Snow Removal Trash Removal Utilities - Electricity Utilities - Gas/Propane Heat of 22
13 Income and Expenses (cont.) Utilities - Oil Heat Utilities - Water/Sewer Utilities - Other Other Household Transportation Car Payments Car Insurance Car Gasoline/Oil Car Maintenance and Repair Car License/Stickers Car Other Tolls Parking Public/Alt. Transportation Other Transportation Child Child Care - Day Care Child Care - Sitters Child Clothing/School Uniforms Child Education Supplies Child Education Books/Fees Child Education Lunches Child Education Transportation Child Education Activities of 22
14 Income and Expenses (cont.) Child Education Room & Board Child Grooming Child Groceries Child Medical Doctor Child Medical Dentist Child Medical Optical Child Medical Medication Child Allowance Child Lessons and Supplies Child Vacation and Camp Child Entertainment Child Tutors Other Child Personal Bank Fees Cell Phone Cigarettes Clothes Dry Cleaning Education for Party Charitable Church/Synagogue/Mosque etc Credit Union (loan) Deferred Compensation of 22
15 Income and Expenses (cont.) Dues/Clubs Employment Uniforms Employment Unreimbursed Travel Employment Unreimbursed Education Entertainment Food/Groceries Gifts Hair Horseback Riding Laundry Legal and Accounting Liquor, Beer, Wine Lottery Tickets Manicure/Pedicure Personal Property Insurance Pets Previous Relship Child Support Previous Relship Alimony Restaurants Stamps and Stationery Sports/Hobbies/Lessons Subscriptions, Books Tax - Local Income Tax of 22
16 Income and Expenses (cont.) Therapist/Counselor Toiletries/Grooming/Drug Store Travel Vacations Voluntary Retirement Other Personal Health and Medical Health Insurance Dental Insurance Disability Insurance Medical/Doctor Dental Drug & Prescription Optical Orthodontist Other Health Other 16 of 22
17 Income and Expenses (cont.) WAGES FOR WIFE Annual wage and salary income, before taxes: NON-WAGE INCOME FOR WIFE Use this sheet to specify income that is not covered on any other sheet. Specify an amount in whichever column (Week, Month, or Year) is most convenient. Child support from previous relationship Alimony from previous relationship Unemployment Compensation Public Assistance Bonuses Commissions Tips Overtime Disability Insurance Workers' Compensation Royalties Rent from Spouse Deferred Compensation of 22
18 Income and Expenses (cont.) Detailed Expenses for Wife: On this data sheet, specify the household, child, and personal expenses of everyday life. The list tries to be comprehensive, but there is no need to fill in every line. Mandatory Deductions Mandatory Retirement Union Dues Other Mandatory Household Rent Condo Fee Homeowners' Insurance Renters' Insurance Real Estate Tax Cable TV Internet Access Phone Household Maintenance Furniture & Appliance Painting/Wallpapering Household Supplies Maid/Cleaning Service Lawn Service Snow Removal Trash Removal Utilities - Electricity Utilities - Gas/Propane Heat of 22
19 Income and Expenses (cont.) Utilities - Oil Heat Utilities - Water/Sewer Utilities - Other Other Household Transportation Car Payments Car Insurance Car Gasoline/Oil Car Maintenance and Repair Car License/Stickers Car Other Tolls Parking Public/Alt. Transportation Other Transportation Child Child Care - Day Care Child Care - Sitters Child Clothing/School Uniforms Child Education Supplies Child Education Books/Fees Child Education Lunches Child Education Transportation Child Education Activities of 22
20 Income and Expenses (cont.) Child Education Room & Board Child Grooming Child Groceries Child Medical Doctor Child Medical Dentist Child Medical Optical Child Medical Medication Child Allowance Child Lessons and Supplies Child Vacation and Camp Child Entertainment Child Tutors Other Child Personal Bank Fees Cell Phone Cigarettes Clothes Dry Cleaning Education for Party Charitable Church/Synagogue/Mosque etc Credit Union (loan) Deferred Compensation of 22
21 Income and Expenses (cont.) Dues/Clubs Employment Uniforms Employment Unreimbursed Travel Employment Unreimbursed Education Entertainment Food/Groceries Gifts Hair Horseback Riding Laundry Legal and Accounting Liquor, Beer, Wine Lottery Tickets Manicure/Pedicure Personal Property Insurance Pets Previous Relship Child Support Previous Relship Alimony Restaurants Stamps and Stationery Sports/Hobbies/Lessons Subscriptions, Books Tax - Local Income Tax of 22
22 Income and Expenses (cont.) Therapist/Counselor Toiletries/Grooming/Drug Store Travel Vacations Voluntary Retirement Other Personal Health and Medical Health Insurance Dental Insurance Disability Insurance Medical/Doctor Dental Drug & Prescription Optical Orthodontist Other Health Other 22 of 22
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