Last Name: Address: City, State, Zip: Phone: Email: Parent/Stepparent #1 Parent/Stepparent #2 First Name: Year of Birth: Students: First Name Year of Birth College Start Year Child #1: Child #2: Child #3: Child #4: Child #5: Other Dependents: (elderly parent, disabled sibling etc.) Primary Residence (Your Home) Information: Year Purchased: Purchase Price: Current Value: Amount Owed: (Mortgage + Equity Line Used) Parent's Income Information: (use estimates or your most recent Federal 1040 if available) Adjusted Gross Income (line 8b from 2019 Federal 1040): Total Federal Income Tax (line 16 from 2019 Federal 1040): Parent/Stepparent #1 Wages: (W2 Box 1) Parent/Stepparent #2 Wages: (W2 Box 1) Annual Retirement Contribution: (401k etc.) Parent's Other Income Information: (Please include Amount and Description) (Child Support Received, Child Support Paid, Business Loss, Social Security, Disability etc.) Parent's Asset Information: Cash and Savings: Investments in Parent's Names: (Investments include Stocks, Bonds, Non-Real Estate, Non-Retirement Investments) Retirement Savings: Net Worth of Business/Farm: Real Estate other than your Primary Residence Year Purchased: Purchase Price: Current Value: Amount Owed: (Mortgage + Equity Line Used) List Other Real Estate Information Here: (Please include the same four items listed above for each property) Children's Financial Information: Savings Tuition Plans Annual Income (Excluding Tuition Plans) (UPlan/UFund/529 Plans) Child #1: Child #2: Child #3: Child #4: Child #5: Divorce/Separation Information: Who is the custodial parent? Parent #1Parent #2 Is Parent #1 re-married? YesNo Is Parent #2 re-married? YesNo Please tell us how you heard about Central Mass CFA: