Verification Form

TO THE SECURITIES COMMISSIONER OF THE STATE OF SOUTH CAROLINA VERIFICATION FORM (Executed WITHIN or WITHOUT of the State of South Carolina) I,________________________________ , declare under penalty of perjury under the laws of the State of South Carolina that I have read the attached financial report and supporting schedules, if any, and know the contents thereof to be true and correct to my best knowledge and belief; and neither the investment adviser nor any partner, officer, or director thereof has any proprietary interest in any account classified solely as that of a customer. If this Verification Form is being filed as part of an initial application for registration, to the best of my knowledge and belief neither the investment adviser nor any partner, officer or director has performed investment advisory services for compensation in the state of South Carolina prior to being registered, or required to register, with the Securities Division. Executed this ________day of ___________________ at ______________________________ ________________________ City, State ________________________________________ (Signature of person signing report) ________________________________________ (Title of person signing report) ________________________________________ _______________________ (Name of Investment Adviser) (CRD Number) INSTRUCTIONS: If the investment adviser is a sole proprietorship, the verification shall be made by the proprietor; if a partnership, by a general partner; or if a corporation, by a duly authorized officer. American LegalNet, Inc. www.FormsWorkFlow.com