Declaration Of Accredited / Expert / Institutional Investor Status printable pdf download

ACCREDITED INVESTOR QUALIFICATION

& VERIFICATION REQUIREMENTS

FOR REG D, RULE 506(c) OFFERINGS

Individual/Couple Qualification

I/we hereby attest, under penalty of perjury, that I/we are an Accredited Investor by virtue of

the fact that I/we meet one of the following criteria. Please check the box next to the applicable

standard shown below by which you believe you qualify:

I am a natural person whose individual net worth or joint net worth with my spouse, at the time

of the purchase of the Securities, exceeds One Million Dollars ($1,000,000), excluding

consideration of equity in my primary residence and after having deducted any negative equity

in my primary residence or any indebtedness that I have incurred on my primary residence

within the sixty (60) days prior to subscribing to this Offering; or

I am a natural person who had individual income in excess of Two Hundred Thousand Dollars

($200,000) in each of the two (2) most recent years or joint income with my spouse in excess of

Three Hundred Thousand Dollars ($300,000) in each of those years and has a reasonable

expectation of reaching the same income level in the current year; or

We are an entity such as an Individual Retirement Account (IRA) or Self Employed Person (SEP)

Retirement Account, and all beneficial owners meet one of the standards defined in bullets 1

and 2 above; or

I am a member of the Manager who is issuing these Securities.

I understand and agree that under the Regulation D, Rule 506(c) exemption from registration,

the Manager may verify my qualifications to subscribe to these Securities by examination of documents

from one or more of the following sources, which I will provide to the Manager or a third party

designated by the Manager. Please check the box next to the applicable documents you will provide for

qualification for this Offering as an individual Accredited Investor:

Income-Based Verification – Copies of any document previously filed with the U.S. Internal

Revenue Service that shows my income (W-2, K-1, 1099, 1040, etc.) for the two most recent

years, along with written verification from me stating that I expect to reach accredited income

levels in the current year.

Net Worth-Based Verification – A copy, within the past three months, of the following: bank

statements, brokerage statements and other statements of securities holdings, certificates of

deposit, tax assessments and appraisal reports issued by independent third parties; a credit

report from at least one of the nationwide consumer reporting agencies is required; and written

statement from the Investor that all liabilities necessary to make a determination of net worth

have been disclosed.

Third-Party Verification – Written confirmation from a registered broker-dealer, an SEC-

registered investment adviser, a licensed attorney, or a certified public accountant that such

Person has taken reasonable steps to verify that the purchaser is an Accredited Investor within

the prior three months and has determined that such purchaser is an Accredited Investor.

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Declaration Of Accredited / Expert / Institutional Investor Status