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FORM ADV

(Paper Version)

•

UNIFORM APPLICATION FOR INVESTMENT ADVISER REGISTRATION

AND

• REPORT BY EXEMPT REPORTING ADVISERS

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 Adv (Paper Version) - Uniform Application For Investment Adviser Registration And Report By Exempt Reporting Advisers Page 2