Sponsors And Selling Agents Broker Dealer Statement {M-10}

NY FORM M-10 STATE OF NEW YORK DEPARTMENT OF LAW BUREAUNew York, NY 10 1-800-788-9898 SPONSORS AND SELLING AGENTS BROKER DEALER STATEMENTAll brokers and dealers whose principal business is in the offering, sale or promotion of condominiums, shares ofcooperative apartment corporations or commercial cooperative corporations, interests in homeowners associations,timeshare projects, senior residences or any other participation interests in real estate, shall submit Form M-10. Out-of-state or foreign must attach a certified copy of a Designation for the Service of Process from the Secretary ofState. Attach additional sheets if space provided is inadequate. For assistance in completing this form, call the Real EstateFinanc: (212) 416-8. Name of Registrant Telephone No.: Address Street City State ZipOther offices, if any 1.Registrant is a [ ] corporation[ ] general partnership[ ] limited partnership[ ] sole proprietor[ ] limited liability company [ ] other: specify Organized under the laws of 2.Registrant is a [ ] sponsor.[ ] selling agent. If a licensed real estate broker, give state license number and expiration date[ ] holder of unsold shares of a cooperative corporation.[ ] purchaser for investment or resale of unsold shares of a cooperative corporation.[ ] seller of interests in a homeowners association. [ ] other: specify 3.If registrant is a new or substitute sponsor, broker or dealer, has this information been disclosed in an offering plan oramendment? Yes [ ] No [ ]Filing fee .......................................... $300 (valid for 4 years)Additional fee for each partner, proprietor, principal, officerdirector............$ 15.00 each Filing fee must accompany this statement. Payment byAttorney's check, company check, certified check, bankcheck or money order. Personal checks not accepted.Make check payable to the NYS Department of Law. Send remittance to:BureauNYS Department of Law ,FloorNew York, NY 10 M-10 () Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com 4.Name of cooperative, condominium, homeowners association, senior residence or timeshare which gave rise to this filing.Address of same 5.The offering or selling will take place in:[ ] New York State only. [ ] New York and other states: specify 6.The offering will be made by: [ ] officers, directors and employees of registrant.[ ] selling agent. If so, give name(s) and address(es): 7. Has registrant, any officer, director, principalpartner ever: A. been suspended or expelled from membership in any securities exchange, association of securities dealers or investment advisers or counsel? ....................Yes [ ] No [ ] B. had a license or registration as a dealer, broker, investment adviser or salesperson denied, suspended or revoked? ..........................................................Yes [ ] No [ ] C. been enjoined or restrained by any court or agency from: 1.the issuance, sale or offer for sale of securities? .............................................Yes [ ] No [ ]2.rendering securities advice or counsel? ...........................................................Yes [ ] No [ ]3.handling or managing trading accounts? .........................................................Yes [ ] No [ ]4.continuing any practices in connection with securities? .................................Yes [ ] No [ ] . been convicted of any crime? ............................................................................... Yes [ ] No [ ] . used or been known by any other name? If 223Yes,224 give other name(s)................ Yes [ ] No [ ] . been the subject of any professional disciplinary proceeding? ............................. Yes [ ] No [ ] . been adjudged a bankrupt or made a general assignment for the benefit of creditors or been an officer, directorprincipal or any entity which waseorganized in bankruptcy, adjudged a bankrupt or made a general assignment for the benefit of creditors? ................................................................Yes [ ] No [ ] . had an offering or selling of securities within the last three years or been an fficer, Yes [ ] No [ ] any answer to any of the above (Question 7) is 223Yes,224 attach statement of full particulars, giving date, nature ofoffense, title and location of agency or court involved, circumstances and final disposition. 8.List names and residence addresses of all securities salespersons (if none, so indicate). American LegalNet, Inc. www.FormsWorkFlow.com 9. Provide the following information for each proprietor, officer, director, principalpartner. Attachcontinuation sheets ifmore space is needed. Complete employment and business affiliation record for the past five years. Include periods of self-employment andunemployment. Include all corporations or other entities where person holds or held a substantial equity or controlling interest. FromMo. Yr.ToMo. Yr.Employer or Business AffiliationNameAddressPosition Held FromMo. Yr.ToMo. Yr.Employer or Business AffiliationNameAddressPosition Held M-10 (/) Page 3 of 4 . Name: Title: Home Address: Phone: Place of Birth: Date of Birth: Social Security No.: . Name: Title: Home Address: Phone: Place of Birth: Date of Birth: Social Security No.: American LegalNet, Inc. www.FormsWorkFlow.com 10. The undersigned constitute all proprietors, officers, directors principalspartners of the registrant.Each hereby Signature Name and Title (Please type or print) Date M-10 ) Page 4 of 4 American LegalNet, Inc. www.FormsWorkFlow.com