Form 133.13 - Application For Renewal Permit

Form 133.13 - Application For Renewal Permit - 2012 Page 2

Form

133.13

Describe the securities registered in Texas (e.g., quantity, type, price per unit, offering

price):

10. Number of shares and dollar amount of securities sold in Texas under current permit:

For the period from:

to:

11. Number of shares and dollar amount of securities sold elsewhere under current permit:

For the period from:

to:

12. Is the renewal fee enclosed? Yes ( ) No ( )

If this fee is not enclosed, a renewal permit will not be issued.

13. Submit one copy of each of the following exhibits:

(a)

opinion of either an independent public accountant or an independent certified public

accountant;

(b)

the most recent financial statement required by the applicable provisions of the Texas

Securities Act, Section 7. If these statements are as of a date more than 90 days prior

to the permit expiration date, interim statements as of a date within the 90-day period

should be filed; and

(c)

up-to-date current prospectus including all material changes and current financial

statements as described in (b) above.

Signed and sealed this

day of

, 20__________

(Name of applicant)

By:

(Title)

Attest:

(Secretary or Partner)

06-13-2012

Form 133.13 - Application For Renewal Permit - 2012 Page 2