IL FORM BB02 Statement for Basis of Exemption from Waiting Period and Disclosure Requirements Illinois Secretary of State Securities Department 421 E. Capitol Ave., 2nd Floor Springfield, IL 62701 217-782-2256 Name of Client or Prospective Client: I, hereby, represent that the client or prospective client named above is either: 1. A natural person who has a net worth or joint net worth with that person's spouse in excess of $1,000,000 at the time of the execution of the Business Broker Agreement; or A natural person who has an income or joint income with that person's spouse in excess of $200,000 in the most recent fiscal year; or A company, business or other non-natural person that has a total asset value in excess of $1,000,000, and has been in existence for at least nine months and was not formed for the purposes of the subject transaction; or A company, business or other non-natural person that has gross revenues or gross sales in excess of $200,000 in the most recent fiscal year, and has been in existence for at least nine months and was not formed for the purposes of the subject transaction; or A company, business or other non-natural person in which at least 90 percent of the entity interest is owned by persons who meet any of the tests set forth in paragraph 1, 2, 3 or 4 above. 2. 3. 4. 5. I, hereby, state that this representation is true and correct. Name of Client Signature Printed by authority of the State of Illinois. November 2015 -- 100 -- SEC 316.1 American LegalNet, Inc. www.FormsWorkFlow.com