NORTH STAR RESOURCE GROUP

Section 1: Personal Information

Client Information

Spouse/Partner Information

Contact Information

Family Information

Section 2: Employment & Income

Client Employment

Spouse/Partner Employment

Other Income Sources

Type	Annual Amount	Duration	Tax Treatment
			Ordinary Income Capital Gains Tax-Free
			Qualified Dividends Ordinary Dividends

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Section 3: Assets & Investments

Retirement Accounts

Type	Owner	Institution	Current Value	Annual Contribution
401(k) 403(b) 457 Traditional IRA Roth IRA SEP-IRA SIMPLE IRA Pension	Client Spouse

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Non-Retirement Investment Accounts

Type	Owner	Institution	Current Value	Cost Basis
Individual Joint Trust 529 Plan UTMA/UGMA

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Real Estate

Property Type	Current Value	Mortgage Balance	Monthly Payment	Interest Rate
Primary Residence Second Home Rental Property Land

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Bank Accounts & Cash

Section 4: Liabilities & Debt

Type of Debt	Balance	Monthly Payment	Interest Rate	Years Remaining
Primary Mortgage
Auto Loans
Student Loans
Credit Cards				N/A

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Section 5: Insurance Review

Life Insurance

Insured	Type	Death Benefit	Premium	Beneficiary
Client Spouse	Term Whole Life Universal Life Variable Life

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Other Insurance

Section 6: Goals & Objectives

Retirement Planning

Financial Goals Priority Ranking

Section 7: Risk Tolerance Assessment