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Form ADV (Paper Version)

UNIFORM APPLICATION FOR INVESTMENT ADVISER REGISTRATION

STATE-REGISTERED INVESTMENT ADVISER EXECUTION PAGE

You must complete the following Execution Page to Form ADV. This execution page must be signed and attached

to your initial application for state registration and all amendments to registration.

1. Appointment of Agent for Service of Process

By signing this Form ADV Execution Page, you, the undersigned adviser, irrevocably appoint the legally

designated officers and their successors, of the state in which you maintain your principal office and place of

business and any other state in which you are applying for registration or amending your registration, as your agents

to receive service, and agree that such persons may accept service on your behalf, of any notice, subpoena,

summons, order instituting proceedings, demand for arbitration, or other process or papers, and you further agree

that such service may be made by registered or certified mail, in any federal or state action, administrative

proceeding or arbitration brought against you in any place subject to the jurisdiction of the United States, if the

action, proceeding or arbitration (a) arises out of any activity in connection with your investment advisory business

that is subject to the jurisdiction of the United States, and (b) is founded, directly or indirectly, upon the provisions

of: (i) the Securities Act of 1933, the Securities Exchange Act of 1934, the Trust Indenture Act of 1939, the

Investment Company Act of 1940, or the Investment Advisers Act of 1940, or any rule or regulation under any of

these acts, or (ii) the laws of the state in which you maintain your principal office and place of business or of any

state in which you are applying for registration, or amending your registration.

2. State-Registered Investment Adviser Affidavit

If you are subject to state regulation, by signing this Form ADV, you represent that, you are in compliance with the

registration requirements of the state in which you maintain your principal place of business and are in compliance

with the bonding, capital, and recordkeeping requirements of that state.

Signature

I, the undersigned, sign this Form ADV on behalf of, and with the authority of, the investment adviser. The

investment adviser and I both certify, under penalty of perjury under the laws of the United States of America, that

the information and statements made in this ADV, including exhibits and any other information submitted, are true

and correct, and that I am signing this Form ADV Execution Page as a free and voluntary act.

I certify that the adviser’s books and records will be preserved and available for inspection as required by law.

Finally, I authorize any person having custody or possession of these books and records to make them available to

federal and state regulatory representatives.

Signature:

____________________________

Date:

______________________

Printed Name: ____________________________

Title:

______________________

Adviser CRD Number: _____________________

Form Sec 1707 - Uniform Application For Investment Adviser Registration - Securities And Exchange Commission Page 47