Form 203-P - Notice Under Section 203(P) Of The Pennsylvania Securities Act Of 1972 Page 5

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9.
Affirmation.
By executing this Form on behalf of the issuer, the signatory affirms that:
A.
The undersigned is familiar with the provisions of Section 203(p) and all
regulations adopted thereunder.
B.
The statements made in this Notice, including all attachments hereto, taken
individually or collectively, are not incomplete in any material respect or false or
misleading with respect to any material fact.
IN WITNESS WHEREOF, this Notice has been duly executed_______________________
(Insert Date)
____________________________________________________
(NAME OF ISSUER)
BY: ________________________________________________
________________________________________________
(TITLE)
21

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