Roth IRA Questionaire

Dear Client:
While most people have heard something about the new Roth IRA, few have received a comprehensive explanation of this dynamic individual retirement account. Enclosed you will find our Roth IRA brochure, which discusses the general mechanics, benefits and issues to consider. After you have reviewed the brochure, we encourage you to call your Rome contact person with any questions.

We have also enclosed a Roth IRA questionnaire. If you complete the questionnaire (as thoroughly as possible) and return it to us using the enclosed pre-addressed envelope, we will call you after considering your particular fact pattern.
We look forward to discussing this exciting opportunity with you.

ROME ASSOCIATES LLP

Name: ___________________________________________________________________
Address: _________________________________________________________________
City: ____________________ State: _______ Zip: __________ Your Age _________
      Spouse’s Age _________
                             Oldest Child’s Age _________
1. Is your spouse the beneficiary of your IRA? ______________
2. What is your anticipated rate of return on your IRA
investments? (1%-15%) 		______________
3. What is your anticipated rate of inflation? (1%-10%) ______________
4. How many years before you plan to take withdrawals from
your IRA? (5-75) 		______________
5. How much do you plan to withdraw from your IRA on
an annual basis? 		______________
6. What effective tax rate should apply to the years you plan
to make IRA contributions? (15%-50%) 		______________
7. What effective tax rate should be used in illustrating the
conversion of your current IRA? (15%-50%)		 ______________
8. What do you anticipate your effective tax rate will be when
you take distributions from your IRA? (15%-50%)		 ______________
9. What is the current value of your IRA? ______________
10. Please provide the amount of nondeductible IRA
contributions made in prior years, if any. 		______________

Return the completed questionnaire today in the envelope provided.
Please call your Rome Associates’ representative at 312.321.0300
if you have any questions.


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541 North Fairbanks Court > Suite 1700 > Chicago > Illinois > 60611
: 312.321.0300 > : 312.321.0364 > : info@romeassoc.com
Copyright 2002