This is for your personal IST ProForma Report

Fact Finder Form

IST ProForma Report Fact Finder Form

"*" indicates required fields

Hidden

Date

Hidden

Agent

Your Name*

Year of Birth*

Your Spouse's Name

Year of Birth

Address*

Street Address City State ZIP Code

Email Address*

Cell Phone #*

Landline Phone #

Property Type*

Property Address or Business Name*

Status of Property*

Date Acquired*

If Residence, # of years Occupied

How Title is Held*

Percent Ownership*

Please enter a number from 0 to 100.

Market Value*

Commission % (if none put 0)*

Please enter a number from 0 to 100.

Cost Basis including additions, improvements*

Depreciation Deducted on Past Years Tax returns (if known)

Total $ of Mortgage(s), Lines of Credit etc. on Property or Business*

Additional cash desired from sale?

Adjusted Gross Income (AGI) from most recent Form 1040*

Net Income from Property or Business from Form 1040*

Signature Required* by typing my name in the box below I attest that I have provided, to the best of my ability, the most accurate information available to me and I request that CB Administrative Services, relying on said information, prepare a ProForma Report of how an IST might work for me. I understand there is not cost to me for this report.*