Notice of Exempt Securities Transactions Under AS 45.55.900(b)(7)(B) (To be filed along with the required fee described at 3 AAC 08.920(6)) Please fill out this form and submit to: Administrator of Securities Alaska Division of Banking, Securities, and Corporations P.O. Box 110807 Juneau, AK 99811-0807 (907) 465-2521 STATUTORY REFERENCE: AS 45.55.900(b) The following transactions are exempted from AS 45.55.070 and 45.55.075: (7) a transaction under an offer to existing security holders of the issuer, including persons who at the time of the transaction are holders of convertible securities, nontransferable warrants, or transferable warrants exercisable within not more than 90 days of their issuance, if (A) a commission or other remuneration, other than a standby commission, is not paid or given directly or indirectly for soliciting a security holder in this state; or (B) the issuer first files a notice specifying the terms of the offer and the administrator does not by order disallow the exemption within the next five full business days; This is a self-executing exemption if there is no commission to be paid under (b)(7)(A). 1. Name, Address, and Telephone number of person filing this notice: Full Name Address Phone Fax The person signing this form must show name & address above. If different from the contact person, show information on signer as well. 2. Name, Address, and Telephone number of Issuer: Name Address Phone 3. Please provide a brief description of terms of the transaction (describe security and price): 4. Date sales are to commence: (may not be sooner than 5 days after the filing date of the exemption notice or as determined by the administrator). 08-109 (rev 8/01) American LegalNet, Inc. www.USCourtForms.com 5. Description of the commission or other remuneration, other than a standby commission, being paid or given directly or indirectly for soliciting a security holder in this state. 6. Describe any special considerations you ask the administrator to consider, including any requests for waiver of any limitations of the exemption. Waiver requests must include full disclosure to the administrator of the facts and relevant material factors relating to the request. Additional information (Please refer to ¶ being amplified): By filing this notice, I affirm that all statutory requirements of AS 45.55.900(b)(7) have been met to date and will continue to be met during the offering period. Signature of attorney or principal ( please describe which) Title Date E-mail address (to receive notice of effectiveness): 08-109 (rev 8/01) American LegalNet, Inc. www.USCourtForms.com