Sales Report For Non-Continuous Offerings {133.11}

Form 133.11 Texas State Securities Board P.O. Box 13167 Austin, Texas 78711-3167 Sales Report for Non-continuous Offerings In order to comply with §113.10, you should furnish the information requested in the tabulation below. If this is to be a final sales report indicate the total expenses of the offering.* PERMIT NO. __________________ FINAL REPORT: G Yes G No For the Period: FROM _________________ TO __________________ 1. 2. Balance UNSOLD in Texas Beginning Period1 Add: Increase of Offering in Texas by Permit Amendment During the Period2 Deduct: Amount SOLD in Texas During Period3 Balance of Authorization in Texas UNSOLD on (Date) _________________ *Total Offering Expenses (to be completed in Final Report ONLY) Total Sales in all States including Texas Name of Issuer: By: Date: 1 # Shares __________ $ Consideration _____________________ __________ __________ _____________________ _____________________ 3. 4. __________ __________ __________ _____________________ _____________________ _____________________ The offering UNSOLD at the beginning of a report period is the BALANCE of authorization UNSOLD at the previous reporting period. For first year Permits this total is the aggregate authorization of the original Permit. 2 3 Increase to authorized offerings result only from formal amendments to Permits. This deduction is the TOTAL amount of any commitments for SHARES SOLD. Liquidations, abandonments or cancellations may not be deducted from the amount of certificates SOLD, nor added to any authorized UNSOLD balance. 08-16-2010 American LegalNet, Inc. www.FormsWorkFlow.com