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FORM ADV-NR

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Signature

I, the undersigned non-resident general partner or non-resident managing agent, certify, under penalty of perjury

under the laws of the United States of America, that the information contained in this Form ADV-NR is true and

correct and that I am signing this Form ADV-NR as a free and voluntary act.

Signature of Partner or Agent:

_____________________________________

Date: _________________________

Printed Name: ____________________________

Title:

_________________________

Mailing Address of Partner or Agent (no P.O. Boxes):

________________________________________________________________________

Signature of Investment Adviser:

_________________________________

Date: _______________________________

Printed Name: ________________________

Title: _______________________________

Adviser SEC File Number: 801-__________

802-__________

Adviser CRD Number: _________________

Adviser Name: _______________________________________________________________

PRIVACY ACT STATEMENT. Section 211(a) of the Advisers Act [15 U.S.C. § 80b-11(a)] authorizes the Commission to collect the information required

by Form ADV-NR. The Commission collects this information to ensure that a non-resident general partner or managing agent of an investment adviser

appoints an agent for service of process in the United States. Filing Form ADV-NR is mandatory for non-resident general partners and non-resident

managing agents of investment advisers. The Commission maintains the information submitted on Form ADV-NR and makes it publicly available. The

Commission may return forms that do not include required information. Intentional misstatements or omissions constitute federal criminal violations under

18 U.S.C. § 1001 and 15 U.S.C. § 80b-17. The information contained in Form ADV-NR is part of a system of records subject to the Privacy Act of 1974, as

amended. The Commission has published in the Federal Register the Privacy Act System of Records Notice for these records.

SEC’S COLLECTION OF INFORMATION. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information

unless it displays a currently valid control number. Section 211(a) of the Advisers Act authorizes the Commission to collect the information on this Form

from applicants. See 15 U.S.C. § 80b-11(a). Filing of this Form is mandatory for non-resident general partners or managing agents of investment advisers.

The principal purpose of this collection of information is to ensure that a non-resident general partner or managing agent of an investment adviser appoints

an agent for service of process in the United States. The Commission will maintain files of the information on Form ADV-NR and will make the

information publicly available. Any member of the public may direct to the Commission any comments concerning the accuracy of the burden estimate on

page one of Form ADV-NR, and any suggestions for reducing this burden. This collection of information has been reviewed by the Office of Management

and Budget in accordance with the clearance requirements of 44 U.S.C. § 3507.

Form Adv-Nr - Appointment Of Agent For Service Of Process By Non-Resident General Partner And Non-Resident Managing Agent Of An Investment Adviser Page 2

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