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2016-699 Emergency Svc - LifeStar Emergency Services -2023, LLC - Application for Services Franchise by Ordinance
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2016-699 Emergency Svc - LifeStar Emergency Services -2023, LLC - Application for Services Franchise by Ordinance
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9/10/2019 9:27:16 AM
Creation date
12/15/2016 11:14:24 AM
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BOCC
Date
12/13/2016
Meeting Type
Work Session
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Others
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6g
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BB&T Personal Financial Statement PAGE 2 <br /> Name: Raymond Travis Dalton Date: 9/20/2016 <br /> Schedule 1 CASH 1 DEPOSIT ACCOUNTS <br /> 1 NAME OF BANK,SAVINGS AND DEMAND TIME NAME OF BANK,SAVINGS AND DEMAND TIME <br /> LOAN,ETC.AND LOCATION DEPOSITS DEPOSITS LOAN,ETC.AND LOCATION DEPOSITS DEPOSITS <br /> ;Allegacy Federal Credit Union $58,467 <br /> Emergency Responders Credit Union $50,436 <br /> TOTAL $108,902 <br /> Schedule 2 LIFE INSURANCE <br /> NAME OF PERSON BENEFICIARY POLICY FACE AMOUNT CASH LOANS AGAINST IS POLICY ASSIGNED? <br /> • INSURED OWNER (DEATH BENEFIT) VALUE POLICY TO WHOM? <br /> Raymond Travis Dalton Lauren Mann Dalton NC Farm Bureau $250,000 $1,800 <br /> Lauren Mann Dalton Raymond Travis Dalton MetLife $350,000 <br /> Raymond Travis Dalton Lauren Mann Dalton ,MetLife $500,000 <br /> TOTAL $1,100,000 $1,800 <br /> Schedule 3 MARKETABLE STOCKS AND BONDS(NYSE,AMEX,NASDAQ) <br /> NUMBER OF SHARES/ CUURENT <br /> DESCRIPTION REGISTERED IN TO WHOM DATE Mme. MARKET <br /> FACE VALUE(BONDS) NAME OF PLEDGED ACQUIRED VALUE/SHARE VALUE <br /> TOTAL <br /> Schedule 4 STOCK IN CLOSELY-HELD CORPORATIONS(Please provide FIS if total value exceedsl0%of your Net Worth) <br /> NUMBER OF ANNUAL <br /> VALUE OF TOTAL SHARES <br /> NAME OF CORPORATION STOCK IN NAME OF SHARES %OWNERSHIP <br /> SHARES OWNED STATEMENT OUTSTANDING <br /> OWNED DATE <br /> TOTAL <br /> Schedule 5 VEHICLES,BOATS,MACHINERY AND EQUIPMENT <br /> DESCRIPTION YEAR COST MARKET LOAN LOAN HOW PAYABLE <br /> (INCLUDE YEAR,MAKE AND MODEL) ACQUIRED VALUE BALANCE PAYABLE TO <br /> 2006 Honda Accord 1-Apr $6,950 per <br /> 1997 Chevrolet Silverado 10/1/2001 $5,475 per <br /> 1995 Honda Accord 7/1/1997 $3,175 per <br /> 1995 Correct Craft-Sport Nautique 2/1/2007 $18,500 $10,800 per <br /> per <br /> per <br /> per <br /> per <br /> + per <br /> pper <br /> TOTAL $26,400 <br /> Please complete all appropriate schedules. If space is inadequate,attach an additional sheet. <br />
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