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<br />ADV All Pages <br /> <br />Page 18 of36 <br /> <br />III C HI <br /> <br />\I [j MS <br /> <br />II C OR <br /> <br />II C WI <br /> <br />III <br />I <br /> <br />Title: <br /> <br />Telephone: <br /> <br />Fax: <br /> <br />Number and Street 1: <br /> <br />Number and Street 2: <br /> <br />City: <br /> <br />State: <br /> <br />Country: <br /> <br />ZIP+4/Postal Code: <br /> <br />Email address, if available: <br /> <br />If this address is a private residence, check this box: C <br />B. Bond/Capital Information, if required by your home state. <br />(1) Name of Issuing Insurance Company: <br /> <br />(2) Amount of Bond: <br />$ .00 <br />(3) Bond Policy Number: <br /> <br />(4) If required by your home state, are you in compliance with your home state's minimum <br />capital requirements? <br /> <br />Yes No <br />C C> <br /> <br />FORM ADV <br />UNIFORM APPLICATION FOR INVESTMENT ADVISER REGISTRATION <br />Iptimary Business Name: PATTERSON & ASSOCIATES IcRD Number: 110735 I <br /> <br />Rev. OS/2003 <br /> <br />IADV - Annual Amendment, Part 18, Page 2 <br />13/29/2004 11:09:50 AM <br /> <br />Ipart 18 Item 2 - Additional Information (Continued) <br /> <br />Yes No <br /> <br />For "yes" answers to the following question, complete a Bond DRP. <br />C. Has a bonding company ever denied, paid out on, or revoked a bond for you? C C <br /> <br />For "yes" answers to the following question, complete a JUdgment/lien DRP: <br />D. Do you have any unsatisfied judgements or liens against you? C (' <br /> <br />For "yes" answers to the following questions, complete an Arbitration DRP: <br />E. Are you, any advisory affiliate, or any management person currently the subject of, or <br />have you, any advisory affiliate, or any management person been the subject of, an <br /> <br />https://crd.nasd.com/Iad/Content/PrintHistl Adv/Pages/crd_iad_Adv AllPages.asp?RefNum=&vi... 2/14/2005 <br />