Form Adv (Paper Version) - Uniform Application For Investment Adviser Registration And Report By Exempt Reporting Advisers Page 4

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Signature
I, the undersigned, sign this Form ADV on behalf of, and with the authority of, the non-resident 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: ____________________

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