Form Si-Ptsupp - Corporate Disclosure Statement - State Of California Secretary Of State Page 2
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1
2State of California
Kevin Shelley
Secretary of State
ATTACHMENT TO
CORPORATE DISCLOSURE STATEMENT
(Domestic Stock and Foreign Corporations)
This Space For Filing Use Only
IMPORTANT — READ INSTRUCTIONS BEFORE COMPLETING THIS FORM
A.
CORPORATE NAME:
B.
ADDITIONAL DIRECTORS (Continued from Item 5 on Form SI-PTSUPP)
ANNUAL
NAMES OF DIRECTORS
SHARES
OPTIONS
BANKRUPTCY
FRAUD
COMPENSATION
6)
YES
NO
YES
NO
7)
YES
NO
YES
NO
8)
YES
NO
YES
NO
9)
YES
NO
YES
NO
10)
YES
NO
YES
NO
11)
YES
NO
YES
NO
12)
YES
NO
YES
NO
13)
YES
NO
YES
NO
14)
YES
NO
YES
NO
15)
YES
NO
YES
NO
16)
YES
NO
YES
NO
17)
YES
NO
YES
NO
18)
YES
NO
YES
NO
19)
YES
NO
YES
NO
20)
YES
NO
YES
NO
IF THE CORPORATION HAS ADDITIONAL DIRECTORS, ATTACH ADDITIONAL PAGES AS NEEDED.
C. ADDITIONAL LOANS TO MEMBERS OF THE BOARD OF DIRECTORS (Continued from Item 7 on Form SI-PTSUPP)
NAMES OF DIRECTORS
DESCRIPTION OF LOAN (INCLUDING AMOUNT AND TERMS)
6)
7)
8)
9)
10)
IF THE CORPORATION HAS MADE ADDITIONAL LOANS TO DIRECTORS, ATTACH ADDITIONAL PAGES AS NEEDED.
D. ADDITIONAL INFORMATION (Please reference item number from Form SI-PTSUPP or Form SI-PTSUPPA, as applicable)
SI-PTSUPPA (REV 04/2003)
APPROVED BY SECRETARY OF STATE
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