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Form Ofr-S-1-91 - Application For Registration Of Securities - Florida Office Of Financial Regulation Page 2

6. Issuer organized under the laws of ____________________________ Date ___________

(a) List the states in which it is proposed to offer the securities for sale to the public.

(b) List the states, if any, in which the securities are eligible for sale to the public.

to the public, or have revoked or suspended the right to sell the securities, or in which an

application has been withdrawn.

PART II.

APPLICANT SHALL FURNISH THE FOLLOWING EXHIBITS, WHERE

APPLICABLE:

Exhibit 1.

Submit one of the following:

(a) Letter of Notification pursuant to Regulation A and supporting documents.

(b) Exhibit 1, Form OFR-S-7-91.

Exhibit 2.

Copy of Articles of Incorporation including amendments thereof, certified by a corporate

officer, if issuer is a corporation; or of articles of association, or of partnership; or of the

instrument under which a trust is created or declared, if issuer is a trust.

Exhibit 3.

By-Laws of Issuer certified by a corporate officer, as amended to date.

Exhibit 4.

Copies of contracts, indenture or other instruments affecting any securities to be offered or of a

material nature to the issuer.

Exhibit 5.

Specimen Copy or Copies of the Security or Securities to be offered.

Exhibit 6.

Financial Statements:

(a) All issuers submitting an application for registration of securities exempt from registration

under the Securities Act of 1933 pursuant to Regulation A or B must submit financial

statements that comply with Section 517.081(3), Florida Statutes, and Rule 69W-

300.002(6), Florida Administrative Code.

(b) All issuers submitting application pursuant to Section 517.081, must submit financial

statements that comply with Section 517.081(3), Florida Statutes, and Rule 69W-

300.002(6), Florida Administrative Code

Exhibit 7.

Copies of all underwriting agreements and other agreements between dealers and distributors.

Exhibit 8.

Issuer's Consent to Service of Process and Corporate Resolution, where applicable, to be

executed upon the Office of Financial Regulation forms provided thereof or Form U-2 and U-

2a.

OFR-S-1-91, Application for Registration of Securities, Effective 11/22/10, Incorporated by Reference in Rule 69W-

301.0002, F.A.C.

Form Ofr-S-1-91 - Application For Registration Of Securities - Florida Office Of Financial Regulation Page 2