PERSONAL INFORMATION

Prepared on May 03, 2012 Personal information for: Name Dorian Mayhew Rothschild Address 60 Arthur St. San Rafael, CA 94901 SSN 123-45-6789 Date of birth May 14, 1986 Phone (415) 464-1554 Occupation: Title Employer Address Phone

Associate Mechanical Engineer Schilling Robotics, Inc 440 Montgomery St. San Francisco, CA 94103 (415) 455-5400

LIVING WILL INFORMATION Relationship _________________

Location of Living Will: 60 Arthur St., San Rafael, CA 94901 BANK ACCOUNTS (checking, savings, time certificates) Account: Name Acct. Type Owner Account: Name Acct. Type Owner Account: Name Acct. Type

Redwood Credit Lenders Checking You

$4,553.00

Redwood Credit Lenders Savings You

$12,530.00

Scottish National Bank CD

$10,000.00

This is a RocketLawyer.com Legal Document

Owner

You
$27,083.00

Total Bank Accounts

STOCKS Stock: Name Schilling Robotics, Inc Owner You Purchase Date October 11, 2009 Number of Shares/Units 155 at $9.78 per share/unit Total Value of Stocks

$1,515.90 $1,515.90

MOTOR VEHICLES Vehicle: Make/Year Owner

2010 Fiat Novello You

$16,500.00

Total Value of Vehicles

$16,500.00

PERSONAL PROPERTY AND HOUSEHOLD FURNISHINGS Property/Furnishings: Description Samsung 48" LED TV Owner You Property/Furnishings: Description Sony Home Entertainment System Owner You Property/Furnishings: Description office desk Owner You Property/Furnishings: Description office chair Owner You

$1,600.00

$1,500.00

$250.00

$150.00

This is a RocketLawyer.com Legal Document

Property/Furnishings: Description bed Owner You Property/Furnishings: Description 3 piece sofa set Owner You Property/Furnishings: Description coffee table Owner You Property/Furnishings: Description microwave Owner You Total Personal Property/Household Furnishings

$1,000.00

$2,500.00

$350.00

$150.00

$7,500.00

LOANS Loan: Lender Borrower Account No. Date of Loan Due Date Payment Interest Rate Collateral Total Loans

Rothschild Lending Services You 124678 February 15, 2010 March 1, 2035 $1,500.00 per month 3% Home

$411,000.00

$411,000.00

GRAND TOTAL - ASSETS AND LIABILITIES Total Bank Accounts Total Value of Stocks Total Vehicles Total Personal Property/Household Furnishings Total Assets Total Loans Total Liabilities
$27,083.00 $1,515.90 $16,500.00 $7,500.00 $52,598.90 $411,000.00 $411,000.00

This is a RocketLawyer.com Legal Document

NET WORTH:

$-358,401.10

AUTO INSURANCE Policy: Company Insured Policy Number Vehicle Insured Date Issued Annual Premium Coverage: Personal Injury Property Damage Medical Payment Uninsured Motorists Underinsured Motorists Comprehensive Collision

B&B Auto Insurance Company Dorian Mayhew Rothschild GR1834566 2010 Fiat Novello March 18, 2010 $1,560.00 Per Person
$15,000.00 $5,000.00 $40,000.00 $0.00 $1,000.00 $150,000.00 $5,000.00

Per Accident
$60,000.00 $20,000.00 $150,000.00 $0.00 $5,000.00 $500,000.00 $15,000.00

Deductible: $1000.00 for accidents in which I am found to be at fault. $0.00 for accidents in which the other party is found to be at fault.

MEDICAL INSURANCE Policy: Company Policy Number Type Date Issued Annual Premium Insured Deductible per Person Deductible per Family Lifetime Maximum

Healthy Living Insurance Company FV1004573 Individual June 24, 2011 $4900.00 Dorian Mayhew Rothschild $3,500.00 $7,000.00 $250,000.00

This is a RocketLawyer.com Legal Document