STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVER S I GHT REAL ESTATE RELATED INFORMATION REQUIRED PURSUANT TO CORPORATIONS CODE SECTION 25102.2 DBO - SB 978 Form (Rev. 12 - 17 ) DEPARTMENT O F BUSINESS OVERSIGHT APP N O ., i f a n y : R E - ( In s e r t App No (s ) of P r e v i ous Fil i ngs B e f o r e t h e D iv i s i o n , i f a n y) C he ck: T r an s a cti o n U n de r Se c ti o n Code 25 1 02 ( e) 2 5 1 0 2 ( f ) 2 5 1 0 2 ( h) 2 5 1 0 2 ( n ) 2 5 1 0 0 ( p) N a m e o f Is s ue r : Iss ue r S t a te ( o r Ot he r J u r is d icti on ) o f I n c o rp o r a ti o n o r O rg an i z a ti o n : Add r e ss o f P r i n ci p a l P l a ce o f Bu s i ne ss: N u m b e r a n d S t re e t City S t a te Zip C ode M a ili n g Add r e ss: N u m b e r a n d S t re e t City S t a te Zip C ode A r e a C o d e a n d T e l e ph on e N u m be r : T itle o f cl a ss ( s) o f s e c ur iti e s to b e s o ld in t h e t r an s a cti o n : 1 . N a m e s a n d titl e s o f t h e iss u e r o f f ic e r s a n d d i r e ct o r s o f t h e c o r p or a ti on , m a na g e r s o f a m a n a g e r - m a n a g e d li m i t e d li a b ility c o m pan y , m e m b e r s o f a m e m be r - m a n a g e d li m i t e d li ab il i ty c o m p an y , g ene r a l pa r t ne r s in a li m it e d p a r t n er s h i p , o r o t he r pe r s on s pe r f o r m i n g si m il ar f un cti o n s f o r o t h e r t y p e s o f iss u e r s. F u ll N a m e T itle If a d d iti o n a l s pa c e is n ee d e d f o r t h e n a m e s, c he ck t h is bo x a n d a t t a c h a s epa ra te s he e t of pa p e r to t h e f o r m a n d l abe l a s I t e m 1. 2. The offering disclosure documents provided to prospective purchasers. Attach the documents to the form and label as Item 2. American LegalNet, Inc. www.FormsWorkFlow.com STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVER SI GHT REAL ESTATE RELATED INFORMATION REQUIRED PURSUANT TO CORPORATIONS CODE SECTION 25102.2 DBO - SB 978 Form (Rev. 12 - 17) Page 2 of 2 3 . L ist a ll st a te an d f e de r a l lic en s e s r e q u i r e d to o ff e r t h e s e c u r iti e s an d en g a g e in re a l e s t a te r e l a t e d a cti v iti e s. L ic en se N u m be r L i c en se E x p i r a ti o n D a te N a m e a n d J u r is d icti o n o f L ic e n si n g Au t ho r ity ( c o m p l e te f o r e a ch lic e n s e ): C a lif o r n ia D e pa r t m en t o f B u si ne ss O v e r si g h t s Di v i s i o n o f C o rp o r a t i ons C a lif o r n ia Fi n a n cing L aw C o r po r a t e Se c u r iti e s L a w o f 19 6 8 B r o k e r - D ea l er I n v e st m e n t Ad v is er C a lif o r n ia D e pa r t m en t o f R e a l E st a t e , R ea l E st a te Law Se c u r iti e s an d E x c ha ng e C o m m issi on FINRA ( Fi nan ci a l I nd u st r y R e g u l a t o r y Au t ho r i t y ) Ot he r If a d d iti o n a l s pa c e is n ee d e d f o r t h e lic en s e s, c he ck t h is b o x an d a t t a ch a s e p a r a te s h e e t of pa p e r to t h e f o r m a n d l abe l a s I t e m 3. 4 . N a m e s, titl e s an d lic en se n u m b e r s o f a ll lic en s e d pe r s on s w h o w ill unde r t a k e a c ti v iti es c on c e r n i n g t h e s e c u r iti e s o ff e r i n g. F u ll N a m e T itle L ic en se N u m ber If a d d iti o n a l s pa c e is n ee d e d f o r t h e n a m e s, c he ck t h is bo x a n d a t t a c h a s epa ra te s he e t of pa p e r to t h e f o r m a n d l abe l a s I t e m 4. Au t h o r i z e d S i g na t u r e o n B e ha l f o f Is s ue r 1 P r i n t N a m e a n d T itle o f S i g na t o r y D a te Name, Address, Phone Number and E - mail of Contact Person 1 T he f o r m m u s t be s i g n ed a nd d ated b y an au t ho ri z e d o ff i c e r , d i r e c to r , g e ne r al pa r tner or t r u s t e e of the i ss uer ( or a pe rs on o cc u p y i ng a p o s i t i o n w i t h t h e i ss uer of eq u i v a l ent r e s p o n s i b i l i t y , or b y the aut h o ri z ed atto r ne y of the iss ue r ). American LegalNet, Inc. www.FormsWorkFlow.com