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<br />ADV All Pages
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<br />Page 35 of36
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<br />investment adviser. The investment adviser and I both certify, under penalty of perjury under the
<br />laws of the United States of America, that the information and statements made in this ADV, including
<br />exhibits and any other information submitted, are true and correct, and that I am signing this Form
<br />ADV Execution Page as a free and voluntary act.
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<br />I certify that the adviser's books and records will be preserved and available for inspection as required
<br />by law. Rnally, I authorize any person having custody or possession of these books and records to
<br />make them available to federal and state regUlatory representatives.
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<br />Signature:
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<br />Date: MM/DO/yyyy
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<br />Printed Name:
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<br />Title:
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<br />Adviser CRD Number:
<br />110735
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<br />I State Registered Investment Adviser Execution Page l
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<br />You must complete the following Execution Page to Form ADV. This execution page must be signed
<br />and attached to your initial application for state registration and all amendments to registration.
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<br />1. Appointment of Agent for Service of Process
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<br />By signing this Form ADV Execution Page, you, the undersigned adviser, irrevocably appoint the
<br />legally designated officers and their successors, of the state in which you maintain your principal
<br />office and place of business and any other state in which you are applying for registration or
<br />amending your registration, as your agents to receive service, and agree that such persons may
<br />accept service on your behalf, of any notice, subpoena, summons, order instituting proceedings,
<br />demand for arbitration, or other process or papers, and you further agree that such service may be
<br />made by registered or certified mail, in any federal or state action, administrative proceeding or
<br />arbitration brought against you in any place subject to the jurisdiction of the United States, If the
<br />action, proceeding, or arbitration (a) arises out of any activity in connection with your investment
<br />advisory business that is subject to the jurisdiction of the United States, and (b) Is founded, directly
<br />or indirectly, upon the provisions of: (I) the Securities Act of 1933, the Securities EXChange Act of
<br />1934, the Trust Indenture Act of 1939, the Investment Company Act of 1940, or the Investment
<br />Advisers Act of 1940, or any rule or regulation under any of these acts, or (II) the laws of the state In
<br />which you maintain your prindpal office and place of business or of any state in which you are
<br />applying for registration or amending your registration.
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<br />2. State-Registered Investment Adviser Affidavit
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<br />If you are subject to state regulation, by signing this Form ADV, you represent that, you are in
<br />compliance with the registration requirements of the state in which you maintain your prlndpal place
<br />of business and are in compliance with the bonding, capital, and recordkeeping requirements of that
<br />state.
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<br />Signature
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<br />I, the undersigned, sign this Form ADV on behalf of, and with the authority of, the investment
<br />adviser. The investment adviser and I both certify, under penalty of perjury under the laws of the
<br />United States of America, that the information and statements made in this ADV, including exhibits
<br />and any other information submitted, are true and correct, and that I am signing this Form ADV
<br />Execution Page as a free and VOluntary act.
<br />
<br />I certify that the adviser's books and records will be preserved and available for inspection as required
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<br />https:/Icrd.nasd.comlIad/Content/PrintHist/ AdvlPages/crd_iad_Adv AllPages.asp?RetNum=&vi... 2/14/2005
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