Tax Efficiency/Roth Conversion Assessment

Your Contact Information

Your name:*

Your Phone Number:

Your E-mail address:*

General Information About You:

Your Age:

Your Approximate Annual Income:

Age you plan to retire:

About Your Spouse or Significant Other (if applicable):

Their Age:

Their Approximate Annual Income:

Their Age plan to retire:

Income Sources in Retirement:
(You can find your Social Security Income on https://www.ssa.gov)

Your Social Security Income at your Full Retirement Age (FRA):

Your Significant Other/Spouse Social Security Income at (FRA):

Your Pension Income at Retirement (if applicable):

Your Significant Other/Spouse Pension Income at Retirement:

Other Sources of Income at Retirement:

Investment Assets:
Your Investment Accounts
Tax Deferred Accounts (Pre-Tax)

IRAs:

401ks/403bs/457s:

Tax-Free Accounts (Roth IRA)

Roth IRAs:

Roth 401ks/403bs/457s:

Non Tax-Deferred Accounts (Stocks, Mutual Funds, etc.):

Annuities:

Other Investment Accounts:

CDs, Money Markets, Checking, Savings:

Your Significant Other/Spouse's Investment Accounts (if applicable)
Tax Deferred Accounts (PreTax)

IRAs:

401ks/403bs/457s:

Tax-Free Accounts (Roth IRA)
Roth IRAs:

Roth 401ks/403bs/457s:

Non Tax-Deferred Accounts (Stocks, Mutual Funds, etc.):

Annuities:

Other Investment Accounts:

CDs, Money Markets, Checking, Savings:

Non-Investable Assets
For property please indicate current value, mortgage balance, interest rate, monthly payment, term.

Primary Residence

Other Property

Additional Notes & Details

Please add any other applicable information:

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