Broker Dealer Affidavit {SBD-1}

John R. Ashcroft Secretary of State State of Missouri Securities Division · 600 W. Main, Rm. 229 · PO Box 1276 Jefferson City, MO 65102 I, Missouri Broker-Dealer Affidavit ("the applicant") and do hereby represent on behalf of the applicant, after having thoroughly searched all applicable records that (check one box per item): 1. The applicant has made NO offers or sales of securities in the State of Missouri. , do hereby swear and affirm that I am a principal of The applicant has made the following offers or sales in the State of Missouri (attach a list of the names, addresses, and telephone numbers of all Missouri clients; the dates and amounts of all trades; and the names and CRD numbers of all agents who transacted business in this state): 2. All owners, control persons, and control affiliates of the applicant are disclosed on the applicant's Form BD. The following owners, control persons, and/or control affiliates were not disclosed on the applicant's Form BD: 3. All disciplinary matters required to be disclosed on Form BD have been disclosed on the applicant's Form BD. The following disciplinary matters to be disclosed on Form BD have not been disclosed: Further affiant sayeth naught. Subscribed and sworn to before me this Notary Public FORM SBD-1 (01/2017) By: Principal of Applicant day of My commission expires: , 20 American LegalNet, Inc. www.FormsWorkFlow.com