FAMILY FOUNDATION PLANNING

ILLUSTRATION REQUEST FORM

^{PROFESSIONAL TAX ADVISOR}

^Name	^Title	^Company Name
Mailing Address
E-mail	Contact Phone Number	Fax

DONOR INFORMATION

Donor Name	Spouse Name
DOB	DOB
Contact Phone Number

Approximate Net Worth $

Approximate AGI   $

Income Tax Bracket   %

Describe the Assets that will be used to fund the family foundation or CRT Advantage™ trust:

Asset Type	Current Value	Cost Basis	Debt	Current Return/ Growth
	$	$	$	%
	$	$	$	%
	$	$	$	%

Projected long term average annual return for foundation or trust:

%

 Additional Comments:

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