IPS Questionnaire

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lt0 \fs18\cf2\f0\charscalex100\b {1 YEAR }\b0 \par\pard\li1426\ri0\sl-440\slmult
0 \*\tx2000\fs24\cf2\f1\charscalex100 {___ }\tab \fs22\cf2\f1\charscalex100 {Ver
y Positive }\par\pard\li1426\ri0\sl-266\slmult0 \*\tx2000\fs24\cf2\f0\charscalex
100 {___ }\tab \fs22\cf2\f1\charscalex100 {Modestly Positive }\par\pard\li1426\r
i0\sl-280\slmult0 \*\tx2000\fs24\cf2\f0\charscalex100 {___ }\tab \fs22\cf2\f1\ch
arscalex100 {Neutral }\par\pard\li1426\ri0\sl-266\slmult0 \*\tx2000\fs24\cf2\f0\
charscalex100 {___ }\tab \fs22\cf2\f1\charscalex100 {Modestly Negative }\par\par
d\li1426\ri0\sl-280\slmult0 \*\tx2000\fs24\cf2\f0\charscalex100 {___ }\tab \fs22
\cf2\f1\charscalex100 {Very Negative }\par\pard\li1426\ri0\sl-280\slmult0 \*\tx2
000\fs24\cf2\f0\charscalex100 {___ }\tab \fs22\cf2\f1\charscalex100 {Unsure }\pa
r\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-333\slmult0 \
fs18\cf2\f0\charscalex100\b {5 YEARS }\b0 \par\pard\li0\ri0\sl-440\slmult0 \*\tx
573\fs24\cf2\f1\charscalex100 {___ }\tab \fs22\cf2\f1\charscalex100 {Very Positi
ve }\par\pard\li0\ri0\sl-266\slmult0 \*\tx573\fs24\cf2\f0\charscalex100 {___ }\t

ab \fs22\cf2\f1\charscalex100 {Modestly Positive }\par\pard\li0\ri0\sl-280\slmul
t0 \*\tx573\fs24\cf2\f0\charscalex100 {___ }\tab \fs22\cf2\f1\charscalex100 {Neu
tral }\par\pard\li0\ri0\sl-266\slmult0 \*\tx573\fs24\cf2\f0\charscalex100 {___ }
\tab \fs22\cf2\f1\charscalex100 {Modestly Negative }\par\pard\li0\ri0\sl-280\slm
ult0 \*\tx573\fs24\cf2\f0\charscalex100 {___ }\tab \fs22\cf2\f1\charscalex100 {V
ery Negative }\par\pard\li0\ri0\sl-280\slmult0 \*\tx573\fs24\cf2\f0\charscalex10
0 {___ }\tab \fs22\cf2\f1\charscalex100 {Unsure }\par\column\pard\li0\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-333\slmult0 \fs18\cf2\f0\charscalex100\b
{10 YEARS }\b0 \par\pard\li0\ri0\sl-440\slmult0 \*\tx573\fs24\cf2\f1\charscalex1
00 {___ }\tab \fs22\cf2\f1\charscalex100 {Very Positive }\par\pard\li0\ri0\sl-26
6\slmult0 \*\tx573\fs24\cf2\f0\charscalex100 {___ }\tab \fs22\cf2\f1\charscalex1
00 {Modestly Positive }\par\pard\li0\ri0\sl-280\slmult0 \*\tx573\fs24\cf2\f0\cha
rscalex100 {___ }\tab \fs22\cf2\f1\charscalex100 {Neutral }\par\pard\li0\ri0\sl266\slmult0 \*\tx573\fs24\cf2\f0\charscalex100 {___ }\tab \fs22\cf2\f1\charscale
x100 {Modestly Negative }\par\pard\li0\ri0\sl-280\slmult0 \*\tx573\fs24\cf2\f0\c
harscalex100 {___ }\tab \fs22\cf2\f1\charscalex100 {Very Negative }\par\pard\li0
\ri0\sl-280\slmult0 \*\tx573\fs24\cf2\f0\charscalex100 {___ }\tab \fs22\cf2\f1\c
harscalex100 {Unsure }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\margl
sxn666\margrsxn93\pard\li773\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li773\ri0\sl213\slmult0 \fs18\cf0\par\pard\li773\ri0\sl-320\slmult0 \fs18\cf2\f0\charscalex1
00\b {PLEASE DESCRIBE YOUR OUTLOOK IN GENERAL REGARDNG INFLATION OVER THE FOLLOW
ING PERIODS}\b0 \par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666
\margrsxn93\cols3\colno1\colw4693\colsr-0\colno2\colw3200\colsr-0\colno3\colw358
6\pard\li1426\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1426\ri0\sl-333\slmult0 \f
s18\cf2\f0\charscalex100\b {1 YEAR }\b0 \par\pard\li1426\ri0\sl-426\slmult0 \*\t
x2000\fs24\cf2\f1\charscalex100 {___ }\tab \fs22\cf2\f1\charscalex100 {It will i
ncrease }\par\pard\li1426\ri0\sl-293\slmult0 \*\tx2000\fs24\cf2\f1\charscalex100
{___}\tab \fs22\cf2\f1\charscalex100 {It will be steady }\par\pard\li1426\ri0\s
l-293\slmult0 \*\tx2000\fs24\cf2\f1\charscalex100 {___}\tab \fs22\cf2\f1\charsca
lex100 {It will decrease }\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\
pard\li0\ri0\sl-333\slmult0 \fs18\cf2\f0\charscalex100\b {5 YEARS }\b0 \par\pard
\li0\ri0\sl-426\slmult0 \*\tx586\fs24\cf2\f1\charscalex100 {___ }\tab \fs22\cf2\
f1\charscalex100 {It will increase }\par\pard\li0\ri0\sl-293\slmult0 \*\tx586\fs
24\cf2\f1\charscalex100 {___}\tab \fs22\cf2\f1\charscalex100 {It will be steady
}\par\pard\li0\ri0\sl-293\slmult0 \*\tx586\fs24\cf2\f1\charscalex100 {___}\tab \
fs22\cf2\f1\charscalex100 {It will decrease }\par\column\pard\li0\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li0\ri0\sl-333\slmult0 \fs18\cf2\f0\charscalex100\b {10
YEARS }\b0 \par\pard\li0\ri0\sl-426\slmult0 \*\tx573\fs24\cf2\f1\charscalex100 {
___ }\tab \fs22\cf2\f1\charscalex100 {It will increase }\par\pard\li0\ri0\sl-293
\slmult0 \*\tx573\fs24\cf2\f1\charscalex100 {___}\tab \fs22\cf2\f1\charscalex100
{It will be steady }\par\pard\li0\ri0\sl-293\slmult0 \*\tx573\fs24\cf2\f1\chars
calex100 {___}\tab \fs22\cf2\f1\charscalex100 {It will decrease }\par\pard\sect\
sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn93\pard\li773\ri0\sl-2
13\slmult0 \fs18\cf0\par\pard\li773\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li773\
ri0\sl-320\slmult0 \fs18\cf2\f0\charscalex100\b {PLEASE DESCRIBE YOUR GOALS/OBJE
CTIVES FOR THESE INVESTMENTS}\b0 \par\pard\li773\ri0\sl-280\slmult0 \fs24\cf0\f0
\charscalex100 {________________________________________________________________
_______ }\par\pard\li773\ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex100 {________
_______________________________________________________________ }\par\pard\li773
\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {________________________________
_______________________________________}\par\pard\li773\ri0\sl-280\slmult0 \fs22
\cf0\f0\charscalex100 {_________________________________________________________
______________ }\par\pard\li773\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {_
______________________________________________________________________}\par\pard
\li786\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li786\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li786\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li786\ri0\sl-213\slmult0 \f
s18\cf0\par\pard\li786\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li786\ri0\sl-213\sl
mult0 \fs18\cf0\par\pard\li786\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li786\ri0\s
l-213\slmult0 \fs18\cf0\par\pard\li786\ri0\sl-320\slmult0 \fs20\cf1\f1\charscale
x100 {F004}\fs20\cf1\f1\charscalex100 {\uc1\u8208XV005}\fs20\cf1\f1\charscalex10

0 {
}\fs20\cf1\f0\char
scalex100\b {IPS}\b0 \fs18\cf1\f0\charscalex100\i { Individual & Family Format}\
i0 \fs18\cf1\f0\charscalex100\i {
}\i0 \fs18\cf1\f0\charscalex100\i {2}\i0
\fs18\cf1\f0\charscalex100\i {
}\i0 \fs18\cf1\f0\charscalex100\i { }\i0 \p
ar\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn93\pard\s
ect\sectd\sbkpage
7;32768}}
\margtsxn666\margbsxn173\pard\li773\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li773\
ri0\sl-373\slmult0 \fs18\cf2\f0\charscalex100\b {WHICH OF THE FOLLOWING BEST DES
CRIBES YOUR GOALS FOR THESE INVESTMENTS? }\b0 \par\pard\sect\sectd\sbknone\pgwsx
n12240\pghsxn15840\marglsxn666\margrsxn93\cols2\colno1\colw6133\colsr-0\colno2\c
olw5346\pard\li1426\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1426\ri0\sl-360\slmu
lt0 \*\tx2000\fs24\cf2\f1\charscalex100 {___ }\tab \fs22\cf2\f1\charscalex100 {T
o assure the safety of the principle }\par\pard\li1426\ri0\sl-293\slmult0 \*\tx2
000\fs24\cf2\f1\charscalex100 {___}\tab \fs22\cf2\f1\charscalex100 {To achieve a
particular investment goal }\par\pard\li1426\ri0\sl-293\slmult0 \*\tx2000\fs24\
cf2\f1\charscalex100 {___}\tab \fs22\cf2\f1\charscalex100 {Other, please explain
: }\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-360\slm
ult0 \*\tx586\fs24\cf2\f1\charscalex100 {___ }\tab \fs22\cf2\f1\charscalex100 {T
o generate income }\par\pard\li0\ri0\sl-293\slmult0 \*\tx586\fs24\cf2\f1\charsca
lex100 {___}\tab \fs22\cf2\f1\charscalex100 {To accumulate assets for retirement
}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn93\pa
rd\li2213\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {_______________________
_____________________________________________}\fs22\cf2\f1\charscalex100 { }\par
\pard\li2213\ri0\sl-266\slmult0 \fs20\cf2\f1\charscalex100 {____________________
________________________________________________}\fs20\cf2\f1\charscalex100 { }\
s18\cf2\f0\charscalex100\b {MOST OF US HAVE SEVERAL OBJECTIVES REGARDING OUR INV
ESTMENTS. PLEASE RANK THE FOLLOWING }\b0 \par\pard\li773\ri0\sl-266\slmult0 \fs1
8\cf2\f0\charscalex100\b {OBJECTIVES IN ORDER OF IMPORTANCE FOR THESE INVESTMENT
S, WITH 1 BEING THE MOST IMPORTANT }\b0 \par\pard\li773\ri0\sl-213\slmult0 \fs18
\cf0\par\pard\li773\ri0\sl-333\slmult0 \fs22\cf2\f1\charscalex100 {_____ Safety/
Capital Preservation (without regard to keeping pace with inflation) }\par\pard\
li773\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {_____ Capital Preservation
(keeping pace with inflation) }\par\pard\li773\ri0\sl-266\slmult0 \fs22\cf2\f1\c
harscalex100 {_____ Growth (outpacing inflati}\fs22\cf2\f1\charscalex100 {on)}\f
s22\cf2\f1\charscalex100 { }\par\pard\li773\ri0\sl-266\slmult0 \fs22\cf2\f1\char
scalex100 {_____ Liquidity (easy access to money) }\par\pard\li773\ri0\sl-266\sl
mult0 \fs22\cf2\f1\charscalex100 {_____ Current Income (i.e., interest & dividen
ds) }\par\pard\li773\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {_}\fs22\cf2\

f1\charscalex100 {____ }\fs22\cf2\f1\charscalex100 {Other, please explain }\par\
pard\li2213\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {_____________________
_______________________________________________}\fs22\cf2\f1\charscalex100 { }\p
ar\pard\li2213\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {__________________
__________________________________________________}\fs22\cf2\f1\charscalex100 {
}\par\pard\li773\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li773\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li773\ri0\sl-386\slmult0 \fs18\cf2\f0\charscalex100\b {WHEN D
O YOU EXPECT TO MAKE WITHDRAWALS FROM THESE INVESTMENTS? }\b0 \par\pard\li1133\r
i0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-320\slmult0 \fs22\cf2\f1\char
scalex100 {___ }\fs22\cf2\f1\charscalex100 {Withdrawals are not expected to be n
eeded from this portfolio }\par\pard\li1133\ri0\sl-266\slmult0 \fs22\cf2\f1\char
scalex100 {___ }\fs22\cf2\f1\charscalex100 {Withdrawals will be needed, but not
until }\par\pard\li1853\ri0\sl-280\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs2
2\cf2\f1\charscalex100 {3 years }\par\pard\li1853\ri0\sl-266\slmult0 \fs22\cf2\f
1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {5 years }\par\pard\li1853\ri0\
sl-266\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {10 y
ears }\par\pard\li1853\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22
\cf2\f1\charscalex100 {More than 10 years }\par\pard\li1853\ri0\sl-266\slmult0 \
fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {Other time period, p
lease describe ________________________________________ }\par\pard\li1133\ri0\sl
-266\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {Withdr
awals will begin immediately and the annual amount of these withdrawals will be
}\par\pard\li1853\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {$____________ o
r _______% of the portfolio value. If the immediate withdrawal is a percentage o
f }\par\pard\li1853\ri0\sl-280\slmult0 \fs22\cf2\f1\charscalex100 {the portfolio
value, how often will the withdrawal amount be recalculated? }\par\pard\li1853\
ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {
End of the prior year }\par\pard\li1853\ri0\sl-266\slmult0 \fs22\cf2\f1\charscal
ex100 {___ }\fs22\cf2\f1\charscalex100 {Beginning of each current year }\par\par
d\li1853\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charsc
alex100 {Other, please describe ________________________________________________
__ }\par\pard\li1493\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {In addition,
for withdrawals beginning immediately, the frequency with which they will occur
will be }\par\pard\li1493\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {ever}\
fs22\cf2\f1\charscalex100 {y:}\fs22\cf2\f1\charscalex100 { }\fs22\cf2\f1\charsc
alex100 {__}\fs22\cf2\f1\charscalex100 {_ month
}\fs22\cf2\f1\charscalex10
0 {___}\fs22\cf2\f1\charscalex100 { quarter
}\fs22\cf2\f1\charscalex100 {_
__}\fs22\cf2\f1\charscalex100 { six months
}\fs22\cf2\f1\charscalex100 {__
_}\fs22\cf2\f1\charscalex100 { year }\par\pard\li773\ri0\sl-213\slmult0 \fs18\c
f0\par\pard\li773\ri0\sl-320\slmult0 \fs18\cf2\f0\charscalex100\b {DO YOU PAY FE
DERAL OR STATE INCOME TAXES? }\b0 \par\pard\sect\sectd\sbknone\pgwsxn12240\pghsx
n15840\marglsxn666\margrsxn93\cols2\colno1\colw3653\colsr-0\colno2\colw7826\pard
\li1493\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1493\ri0\sl-333\slmult0 \fs22\cf
2\f1\charscalex100 {__}\fs22\cf2\f1\charscalex100 {_ Yes }\par\column\pard\li0\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-333\slmult0 \fs22\cf2\f1\charsc
alex100 {___}\fs22\cf2\f1\charscalex100 { No }\par\pard\sect\sectd\sbknone\pgws
xn12240\pghsxn15840\marglsxn666\margrsxn93\pard\li773\ri0\sl-213\slmult0 \fs18\c
f0\par\pard\li773\ri0\sl-320\slmult0 \fs22\cf2\f1\charscalex100 {If yes, what is
your top marginal federal tax bracket: _________% }\par\pard\li773\ri0\sl-266\s
lmult0 \fs22\cf2\f1\charscalex100 {If}\fs22\cf2\f1\charscalex100 { state taxes a
re applicable, what is your top marginal state tax bracket: }\fs22\cf2\f1\charsc
alex100 {_________%}\fs22\cf2\f1\charscalex100 { }\par\pard\li786\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li786\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li786\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li786\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li78
6\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li786\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li786\ri0\sl-413\slmult0 \fs20\cf1\f1\charscalex100 {F004}\fs20\cf1\f1\chars
calex100 {\uc1\u8208XV005}\fs20\cf1\f1\charscalex100 {
}\fs20\cf1\f0\charscalex100\b {IPS}\b0 \fs18\cf
1\f0\charscalex100\i { Individual & Family Format}\i0 \fs18\cf1\f0\charscalex100

\i {
}\i0 \fs18\cf1\f0\charscalex100\i {3}\i0 \fs18\cf1\f0\charscalex100\i
{
}\i0 \fs18\cf1\f0\charscalex100\i { }\i0 \par\pard\sect\sectd\sbknone\pg
wsxn12240\pghsxn15840\marglsxn666\margrsxn93\pard\sect\sectd\sbkpage
7;32768}}
ri0\sl-373\slmult0 \fs18\cf2\f0\charscalex100\b {WHAT TAX CONSIDERATIONS SHOULD
BE KEPT IN MIND WHEN MANAGING THESE INVESTMENTS? }\b0 \par\pard\li1133\ri0\sl-21
3\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-333\slmult0 \fs22\cf2\f1\charscalex10
0 {___ }\fs22\cf2\f1\charscalex100 {The portfolio is entirely tax deferred. Tax
minimization is not a concern. }\par\pard\li1133\ri0\sl-266\slmult0 \fs22\cf2\f1
\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {There are tax loss carry\uc1\u8
208Xforwards which can be utilized to reduce future taxes. }\par\pard\li1133\ri0
\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {Thi
s portfolio should be managed to minimize taxes. }\par\pard\li1133\ri0\sl-266\sl
mult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {Other: ______
______________________________________________________________ }\par\pard\li773\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li773\ri0\sl-333\slmult0 \fs18\cf2\f0\char
scalex100\b {WHAT IS YOUR KNOWLEDGE OF INVESTMENTS? }\b0 \par\pard\li1493\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li1493\ri0\sl-320\slmult0 \fs22\cf2\f1\charscale
x100 {__}\fs22\cf2\f1\charscalex100 {_ None
}\fs22\cf2\f1\charscalex100 {_
__}\fs22\cf2\f1\charscalex100 { Limited
}\fs22\cf2\f1\charscalex100 {___}\
fs22\cf2\f1\charscalex100 { Good
}\fs22\cf2\f1\charscalex100 {___}\fs22\cf
2\f1\charscalex100 { Extensive }\par\pard\li773\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li773\ri0\sl-320\slmult0 \fs18\cf2\f0\charscalex100\b {WHAT IS YOUR INVES
TMENT TEMPERMENT? }\b0 \par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li
1133\ri0\sl-320\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex
100 {I/we are more interested in conserving capital than in seeking growth. I/we
prefer to accept moderate }\par\pard\li1853\ri0\sl-266\slmult0 \fs22\cf2\f1\cha
rscalex100 {income and little or no growth in exchange for stability and minimum
risk. }\par\pard\li1133\ri0\sl-280\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs
22\cf2\f1\charscalex100 {I/we understand that in order to achieve higher returns
, it is necessary to take some risk. I/we are }\par\pard\li1853\ri0\sl-266\slmul
t0 \fs22\cf2\f1\charscalex100 {willing to accept moderate volatility in the valu
e of the portfolio in exchange for greater income }\par\pard\li1853\ri0\sl-266\s
lmult0 \fs22\cf2\f1\charscalex100 {and/or growth potential. }\par\pard\li1133\ri
0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {I/
we understand that in order to achieve higher returns, it is necessary to take s
ome risk. I/we are }\par\pard\li1853\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex1
00 {willing to be more aggressive and face greater risk in order to pursue the p
ossibility of above }\par\pard\li1853\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex
100 {average rates of return. }\par\pard\li773\ri0\sl-213\slmult0 \fs18\cf0\par\

pard\li773\ri0\sl-333\slmult0 \fs18\cf2\f0\charscalex100\b {ALL INVESTMENT DECIS
IONS INVOLVE A TRADE\uc1\u8208XOFF BETWEEN RETURNS AND RISK \uc1\u8211X THE GREA
TER THE }\b0 \par\pard\li773\ri0\sl-266\slmult0 \fs18\cf2\f0\charscalex100\b {PO
TENTIAL FOR HIGHER RETURNS, THE GREATER THE VOLATILITY OF THOSE RETURNS, INCLUDI
NG THE }\b0 \par\pard\li773\ri0\sl-266\slmult0 \fs18\cf2\f0\charscalex100\b {POT
ENTIAL FOR LOSSES. WHAT INFLUENCES YOU THE MOST WHEN MAKING IMPORTANT INVESTMENT
}\b0 \par\pard\li773\ri0\sl-266\slmult0 \fs18\cf2\f0\charscalex100\b {DECISIONS
? }\b0 \par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-320\
slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {Mainly conc
erned with achieving high gains. }\par\pard\li1133\ri0\sl-280\slmult0 \fs22\cf2\
f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {More influenced by the potent
ial to achieve higher gains than the potential for loss. }\par\pard\li1133\ri0\s
l-266\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {More
influenced by the potential loss than the potential for higher gains. }\par\pard
\li1133\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charsca
lex100 {More concerned with the potential loss. }\par\pard\li773\ri0\sl-213\slmu
lt0 \fs18\cf0\par\pard\li773\ri0\sl-320\slmult0 \fs18\cf2\f0\charscalex100\b {WH
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LUCTUATIONS IN }\b0 \par\pard\li773\ri0\sl-266\slmult0 \fs18\cf2\f0\charscalex10
0\b {YOUR INVESTMENT PORTFOLIO? }\b0 \par\pard\li1133\ri0\sl-213\slmult0 \fs18\c
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\f1\charscalex100 {I/we would be extremely uneasy about any fluctuations in the
value of the investments. }\par\pard\li1133\ri0\sl-280\slmult0 \fs22\cf2\f1\char
scalex100 {___ }\fs22\cf2\f1\charscalex100 {I/we would be very concerned about s
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ar\pard\li1853\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {the extreme. }\par
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arscalex100 {I/we would have some concern about short\uc1\u8208Xterm fluctuation
s in the value of the investments. }\par\pard\li1133\ri0\sl-266\slmult0 \fs22\cf
2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {I/we would have very little
concern about short\uc1\u8208Xterm fluctuations in the value of the investments
. }\par\pard\li773\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li773\ri0\sl-320\slmult
0 \fs18\cf2\f0\charscalex100\b {PLEASE CHOOSE THE STATEMENT THAT BEST REFLECTS Y
OUR ATTITUDE }\b0 \par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\
ri0\sl-333\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {
I/we would rather be out of the stock market when it goes down than in the marke
t when it goes up. }\par\pard\li1133\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex1
00 {___ }\fs22\cf2\f1\charscalex100 {I/we would rather be in the stock market wh
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ri0\sl-373\slmult0 \fs18\cf2\f0\charscalex100\b {IF YOU COULD INCREASE YOUR CHAN
CE OF ACHIEVING ALL YOUR GOALS BY TAKING MORE RISK, YOU }\b0 \par\pard\li773\ri0
\sl-280\slmult0 \fs18\cf2\f0\charscalex100\b {WOULD: }\b0 \par\pard\li1133\ri0\s
l-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-320\slmult0 \fs22\cf2\f1\charscal
ex100 {___ }\fs22\cf2\f1\charscalex100 {Be unlikely to take much more risk. }\pa
r\pard\li1133\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\c
harscalex100 {Be willing to take a little more risk with some of your money. }\p
ar\pard\li1133\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\
charscalex100 {Be}\fs22\cf2\f1\charscalex100 { willing to take a little more ris
k with all of your money. }\par\pard\li1133\ri0\sl-266\slmult0 \fs22\cf2\f1\char
scalex100 {___ }\fs22\cf2\f1\charscalex100 {Be willing to take a lot more risk w
ith all of your money. }\par\pard\li773\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li
773\ri0\sl-333\slmult0 \fs18\cf2\f0\charscalex100\b {HOW LONG WOULD YOU BE PREPA
RED TO WAIT TO RECOVER FROM A DOWNWARD FLUCTUATION IN YOUR }\b0 \par\pard\li773\
ri0\sl-266\slmult0 \fs18\cf2\f0\charscalex100\b {INVESTMENT}\b0 \fs18\cf2\f0\cha
rscalex100\b {S?}\b0 \fs18\cf2\f0\charscalex100\b { }\b0 \par\pard\li773\ri0\sl266\slmult0 \fs22\cf2\f1\charscalex100 {Except for the Great Depression, the lon
gest time investors had to wait after a stock market crash for their }\par\pard\
li773\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {portfolio to return to its
earlier value has been 4 years for stocks and 2 years for bonds. Knowing this an
d }\par\pard\li773\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {knowing that i
t is impossible to protect an investor from an occasional loss if the investor c
hooses to invest at }\par\pard\li773\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex1
00 {least some of their portfolio in stocks and bonds, please check one of the f
ollowing to indicate how long you are }\par\pard\li773\ri0\sl-266\slmult0 \fs22\
cf2\f1\charscalex100 {willing to wait to recover your losses: }\par\pard\li1133\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-333\slmult0 \fs22\cf2\f1\cha
rscalex100 {___ }\fs22\cf2\f1\charscalex100 {Less than one year}\fs22\cf2\f1\cha
rscalex100 {.*}\fs22\cf2\f1\charscalex100 { }\par\pard\li1133\ri0\sl-266\slmult0
\fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {Between one and tw
o years}\fs22\cf2\f1\charscalex100 {.*}\fs22\cf2\f1\charscalex100 { }\par\pard\l
i1133\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {_}\fs22\cf2\f1\charscalex10
0 {__ }\fs22\cf2\f1\charscalex100 {Between two and three years}\fs22\cf2\f1\char
scalex100 {.*}\fs22\cf2\f1\charscalex100 { }\par\pard\li1133\ri0\sl-266\slmult0
\fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {Over three years. }
\par\pard\li773\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li773\ri0\sl-320\slmult0 \
fs22\cf2\f1\charscalex100 {*If you selected a period of three years or less, are
you prepared to substantially reduce your goals as result of }\par\pard\li773\r
i0\sl-280\slmult0 \fs22\cf2\f1\charscalex100 {not willing to accept more risk? }
\par\pard\li1493\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1493\ri0\sl-320\slmult0
\fs22\cf2\f1\charscalex100 {__}\fs22\cf2\f1\charscalex100 {_ Yes

}\fs22\c
f2\f1\charscalex100 {___}\fs22\cf2\f1\charscalex100 { No }\par\pard\li773\ri0\s
x100\b {WHICH INVESTMENT WOULD YOU BE MORE COMFORTABLE OWNING? }\b0 \par\pard\li
773\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {The chart below shows the his
torical range of values for five different investments of $100,000 after one yea
r. }\par\pard\li773\ri0\sl-280\slmult0 \fs22\cf2\f1\charscalex100 {Please choose
the one you would prefer owning: }\par\pard\li773\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li773\ri0\sl-320\slmult0 \fs22\cf2\f1\charscalex100 {__}\fs22\cf2\f1\ch
arscalex100 {_ Investment A
}\fs22\cf2\f1\charscalex100 {___}\fs22\cf2\f1\
charscalex100 { Investment B
}\fs22\cf2\f1\charscalex100 {___}\fs22\cf2\f1
\charscalex100 { Investment C
}\fs22\cf2\f1\charscalex100 {___}\fs22\cf2\f
1\charscalex100 { Investment D
}\fs22\cf2\f1\charscalex100 {___}\fs22\cf2\
f1\charscalex100 { Investment E }\par\pard\li1186\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li1186\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1186\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1186\ri0\sl-426\slmult0 \fs20\cf0\f1\charscalex100 { $160,0
00 }\par\pard\li1200\ri0\sl-293\slmult0 \fs20\cf0\f1\charscalex100 { $140,000
}\par\pard\li1213\ri0\sl-306\slmult0 \fs20\cf0\f1\charscalex100 { $120,000 }\pa
r\pard\li1240\ri0\sl-293\slmult0 \fs20\cf0\f1\charscalex100 { $100,000 }\par\pa
rd\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn93\cols7\colno
1\colw2760\colsr-0\colno2\colw986\colsr-0\colno3\colw1026\colsr-0\colno4\colw108
0\colsr-0\colno5\colw1160\colsr-0\colno6\colw1920\colsr-0\colno7\colw2546\pard\l
i1360\ri0\sl-280\slmult0 \fs20\cf0\f1\charscalex100 { $80,000 }\par\pard\li1373
\ri0\sl-293\slmult0 \fs20\cf0\f1\charscalex100 { $60,000 }\par\pard\li1386\ri0\
sl-280\slmult0 \fs20\cf0\f1\charscalex100 { $40,000 }\par\pard\li1400\ri0\sl-28
0\slmult0 \fs20\cf0\f1\charscalex100 { $20,000 }\par\pard\li1826\ri0\sl-280\slm
ult0 \fs20\cf0\f1\charscalex100 { $\uc1\u8208X
}\par\column\pard\li0\ri0\sl-2
13\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-293\slmult0 \fs20\cf0\f1\ch
arscalex100 {A }\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\r
i0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pa
rd\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li0\ri0\sl-426\slmult0 \fs20\cf0\f1\charscalex100 {B }\par\column\pard\li
0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\par
d\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par
\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0
\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18
\cf0\par\pard\li0\ri0\sl-346\slmult0 \fs20\cf0\f1\charscalex100 {C }\par\column\
pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \f
s18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-266\sl
mult0 \fs20\cf0\f1\charscalex100 {D }\par\column\pard\li0\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-426\slmult0 \fs20\cf0\f1\charscalex10
0 {E }\par\column\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f1\charscalex100 {Very P
oor Market }\par\pard\li0\ri0\sl-360\slmult0 \fs20\cf0\f1\charscalex100 {Normal
Market }\par\pard\li0\ri0\sl-360\slmult0 \fs20\cf0\f1\charscalex100 {Very Good M
arket }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn
93\pard\li773\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li773\ri0\sl-373\slmult0 \fs
20\cf2\f1\charscalex100 {
}\fs20\cf2\f1\charscalex100 { Market Return }\par\pard
f1\charscalex100 {F004}\fs20\cf1\f1\charscalex100 {\uc1\u8208XV005}\fs20\cf1\f1\

charscalex100 {
}\fs20
\cf1\f0\charscalex100\b {IPS}\b0 \fs18\cf1\f0\charscalex100\i { Individual & Fam
ily Format}\i0 \fs18\cf1\f0\charscalex100\i {
}\i0 \fs18\cf1\f0\charscalex
100\i {5}\i0 \fs18\cf1\f0\charscalex100\i {
}\i0 \fs18\cf1\f0\charscalex100
\i { }\i0 \par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margr
sxn93\pard\sect\sectd\sbkpage
7;32768}}
ri0\sl-373\slmult0 \fs18\cf2\f0\charscalex100\b {WHICH STATEMENT BEST REFLECTS Y
OUR ATTITUDE ABOUT INVESTING IN THE STOCK MARKET? }\b0 \par\pard\li1133\ri0\sl-2
13\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-333\slmult0 \fs22\cf2\f1\charscalex1
00 {___}\fs22\cf2\f1\charscalex100 { I/we are unwilling to experience any reduct
ion in the value of investments. }\par\pard\li1133\ri0\sl-266\slmult0 \fs22\cf2\
f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {I/we can tolerate infrequent,
very limited declines (less than }\fs22\cf2\f1\charscalex100 {10}\fs22\cf2\f1\c
harscalex100 {%) through difficult phases in a stock }\par\pard\li1853\ri0\sl-26
6\slmult0 \fs22\cf2\f1\charscalex100 {market cycle. }\par\pard\li1133\ri0\sl-266
\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {I/we can t
olerate limited declines (}\fs22\cf2\f1\charscalex100 {10}\fs22\cf2\f1\charscale
x100 {\uc1\u8208X}\fs22\cf2\f1\charscalex100 {20}\fs22\cf2\f1\charscalex100 {%)
through difficult phases in a stock market cycle. }\par\pard\li1133\ri0\sl-266\s
lmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {I/we can tol
erate periods of moderately negative returns (declines of }\fs22\cf2\f1\charscal
ex100 {20}\fs22\cf2\f1\charscalex100 {\uc1\u8208X}\fs22\cf2\f1\charscalex100 {35
}\fs22\cf2\f1\charscalex100 {%) to achieve potentially }\par\pard\li1853\ri0\sl280\slmult0 \fs22\cf2\f1\charscalex100 {higher investment returns and recognize
that negative returns could persist for a year or more. }\par\pard\li1133\ri0\sl
-266\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100 {I/we c
an tolerate periods of significant negative returns (greater than }\fs22\cf2\f1\
charscalex100 {35}\fs22\cf2\f1\charscalex100 {%) for the chance to maximize }\pa
r\pard\li1853\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {the long term retur
ns and recognize and accept that negative returns could persist for a year or }\
par\pard\li1853\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {more. }\par\pard\
li773\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li773\ri0\sl-320\slmult0 \fs18\cf2\f
0\charscalex100\b {SOME INVESTORS REQUIRE A SPECIFIC PORTION OF THEIR PORTFOLIO
REMAIN AS CASH (MONEY MARKET }\b0 \par\pard\li773\ri0\sl-266\slmult0 \fs18\cf2\f
0\charscalex100\b {FUNDS) FOR EASY ACCESS. PLEASE DESCRIBE YOUR SITUATION REGARD
ING LIQUIDITY: }\b0 \par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li113
3\ri0\sl-333\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex100
{No minimum liquidity needs (no minimum cash holdings necessary). }\par\pard\li
1133\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {___ }\fs22\cf2\f1\charscalex
100 {A minimum of _________% of total investments should be held as cash/cash eq
uivalents. }\par\pard\li1133\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {___
}\fs22\cf2\f1\charscalex100 {At least $____________ in cash/cash equivalents. }\
s22\cf2\f1\charscalex100 {For how long will these needs apply? }\par\pard\li773\
ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {_________________________________
_____________________________________________________}\fs22\cf2\f1\charscalex100
{ }\par\pard\li773\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {_____________
_________________________________________________________________________}\par\p
ard\li773\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li773\ri0\sl-333\slmult0 \fs16\c
f2\f0\charscalex100\b {YOU MAY CHOOSE TO AVOID CERTAIN INVESTMENTS FOR SOCIAL RE
ASONS. PLEASE CHECK ALL CATEGORIES }\b0 \par\pard\li773\ri0\sl-266\slmult0 \fs18
\cf2\f0\charscalex100\b {THAT YOU PREFER NOT TO INVEST IN: }\b0 \par\pard\li773\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li773\ri0\sl-293\slmult0 \fs20\cf2\f1\char
scalex100 {__}\fs20\cf2\f1\charscalex100 {_}\fs20\cf2\f1\charscalex100 { }\fs20
\cf2\f1\charscalex100 {Alcohol}\fs20\cf2\f1\charscalex100 {
}\fs20\cf2\f1\c
harscalex100 {___}\fs20\cf2\f1\charscalex100 { Genocide}\fs20\cf2\f1\charscalex
100 {
}\fs20\cf2\f1\charscalex100 {___}\fs20\cf2\f1\charscalex100 { }\fs20
\cf2\f1\charscalex100 {Gambling}\fs20\cf2\f1\charscalex100 {
}\fs20\cf2\f1\
charscalex100 {___}\fs20\cf2\f1\charscalex100 { }\fs20\cf2\f1\charscalex100 {Mi
litary Weapons/Firearms}\fs20\cf2\f1\charscalex100 {
}\fs20\cf2\f1\charscal
ex100 {___}\fs20\cf2\f1\charscalex100 { }\fs20\cf2\f1\charscalex100 {Nuclear Po
wer}\fs20\cf2\f1\charscalex100 {
}\fs20\cf2\f1\charscalex100 {___}\fs20\cf2
\f1\charscalex100 { }\fs20\cf2\f1\charscalex100 {Tobacco }\par\pard\li773\ri0\s
x100\b {DESCRIBE ANY OTHER INVESTMENTS THAT YOU MAY WISH TO EXCLUDE FROM YOUR IN
VESTMENTS: }\b0 \par\pard\li773\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li773\ri0\
sl-333\slmult0 \fs22\cf2\f1\charscalex100 {_____________________________________
_________________________________________________}\fs22\cf2\f1\charscalex100 { }
\par\pard\li773\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {_________________
_____________________________________________________________________}\par\pard\
li773\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {___________________________
___________________________________________________________}\fs22\cf2\f1\charsca
lex100 { }\par\pard\li773\ri0\sl-266\slmult0 \fs22\cf2\f1\charscalex100 {_______
_______________________________________________________________________________}
\par\pard\li773\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li773\ri0\sl-333\slmult0 \
fs18\cf2\f0\charscalex100\b {PLEASE CHECK THE FOLLOWING BOX TO DEMONSTRATE THAT
YOU UNDERSTAND THE ADVISOR HAS FULL }\b0 \par\pard\li773\ri0\sl-266\slmult0 \fs1
8\cf2\f0\charscalex100\b {DISCRETION OVER TRADING IN YOUR ACCOUNTS INCLUDING ANY
NEEDED REBALANCING: }\b0 \par\pard\li1493\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li1493\ri0\sl-320\slmult0 \fs22\cf2\f1\charscalex100 {___}\fs22\cf2\f1\charscal
ex100 { I/we concur }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\margl
sxn666\margrsxn93\cols2\colno1\colw2933\colsr-0\colno2\colw8546\pard\li773\ri0\s
l-213\slmult0 \fs18\cf0\par\pard\li773\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li7
73\ri0\sl-386\slmult0 \fs22\cf2\f1\charscalex100 {Client Signature: }\par\pard
f1\charscalex100 {Date:
}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\p
ar\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-386\slmult0 \fs22\c
f2\f1\charscalex100 {_________________________________________________}\fs22\cf2
\f1\charscalex100 { }\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0
\sl-320\slmult0 \fs22\cf2\f1\charscalex100 {_________________________}\fs22\cf2\
f1\charscalex100 { }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsx
n666\margrsxn93\pard\li773\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li773\ri0\sl-32
0\slmult0 \fs22\cf2\f1\charscalex100 {Co}\fs22\cf2\f1\charscalex100 {\uc1\u8208X
Client Signature:
}\fs22\cf2\f1\charscalex100 {______________________________
___________________}\fs22\cf2\f1\charscalex100 { }\par\pard\sect\sectd\sbknone\p
gwsxn12240\pghsxn15840\marglsxn666\margrsxn93\cols2\colno1\colw2933\colsr-0\coln
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calex100\i { Individual & Family Format}\i0 \fs18\cf1\f0\charscalex100\i {
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