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CONFIDENTIAL <br /> 13B&T <br /> Personal Financial Statement <br /> AS OF: September 20, 2016 <br /> TO: BB&T <br /> Name Raymond Travis Dalton Date of Birth January 19, 1977 <br /> Address 1186 Badgett Road i✓SSN r mN ***-**-1921 • <br /> King, NC 27021 Residence Phone 336-983-5074 <br /> Position or Occupation Logistics Manager <br /> Business Name LifeStar Emergency Services, LLC <br /> Business Address 3475 Myer Lee Drive Business Phone 336-722-5433 <br /> Winston-Salem, NC 27101 <br /> This is a(n) r Individual Financial Statement l� ,Joint Financial Statement. If joint, complete the following: <br /> Joint Name Lauren Mann Dalton Date of Birth July 25, 1980 <br /> l SSN E mN ***-**-6922 <br /> Position or Occupation Nurse <br /> Business Name Novant Health-Forsyth Medical Center <br /> Business Address 3333 Silas Creek Parkway Business Phone 336-718-3160 <br /> Winston-Salem, NC 27103 <br /> *List all amounts in dollars. Omit Cents. <br /> ASSETS AMOUNT LIABILITIES AND NET WORTH AMOUNT <br /> Cash/Deposit Accounts(Sch.1) $108,902 Accounts Payable <br /> Cash Value of Life Insurance(Sch.2) $1,800 Loans on Life insurance(Sch.2) <br /> Notes and Accounts Receivable Income Taxes Due <br /> Marketable Stocks&Bonds(Sch.3) Liab of Partnerships/Joint Ventures <br /> Stock in Closely Held Corporations(Sch.4) Loans on Vehicles,Boats,etc.(Sch.5) <br /> Assets in Partnerships&Joint Ventures Loans on Real Estate(Sch.6) $254,516 <br /> Vehicles,Boats,Machinery,&Equipment(Sch.5) $26,400 Other Loans Payable(Sch.9) <br /> Real Estate(Sch.6) $465,400 Other Liabilities: <br /> Vested Interest in Pension/Retirement Accts.(Sch.7) $199,400 <br /> Other Assets(Sch.8) <br /> Total Liabilities $254,516 <br /> Net Worth $547,387 <br /> Total Assets $801,903 Total Liabilities&Net Worth $801,903 <br /> Please complete all appropriate schedules. If space is inadequate,attach an additional sheet. <br />