Pursuant to s. DFI-Sec 5.05(7), Wis. Adm. Code, every registered investment adviser shall employ at its principal office or designated office of supervision in accordance with s. DFI-Sec 5.03(1), Wis. Adm. Code, at least one person designated in writing to the administrator to act in a supervisory capacity who is registered as an investment adviser representative in this state and has satisfied the examination requirement in s. DFI-Sec 5.01(5). FIRM222S NAME: FIRM222S ADDRESS If the firm wishes to designate more than one supervisor, submit one form for each supervisor designated. NAME OF DESIGNATED SUPERVISOR: HOME ADDRESS OF DESIGNATED SUPERVISOR: ADDRESS OF OFFICE OF EMPLOYMENT: (Must be Principal or Designated Office) DATE QUALIFIED/PENDING IN WISCONSIN: SUPERVISOR CRD # TYPED NAME AND TITLE OF SIGNATORY SIGNATURE DATE This Division is to be notified within 10 days of any change in designated supervisor. Failure to do so will be cause for a delinquent filing fee of $100 pursuant to s. DFI-Sec 7.01(6)(g), Wis. Adm. Code. (Please refer to s. DFI 5.04(4), Wis. Adm. Code.) American LegalNet, Inc. www.FormsWorkFlow.com