OFFICE OF THE SECURITIES COMMISSIONER OF KANSAS FORM K-1 FINAL SALES REPORT or RENEWAL APPLICATION Please indicate the type of filing by check-mark or ''X'' below: Final Sales Report to terminate the securities registration in Kansas and to meet the requirements of K.S.A. 17-1261(m)(3). (Complete Items 1 through 4 below. See NOTE under Item 4.) Renewal Application to extend the registration of securities and to report sales in Kansas (Complete all Items and pay fee.) File No. 1. Issuer Name and Address: 2. Correspondent Name, Address and Phone No.: 3. Description of Securities: 4. Amount previously registered in Kansas: $ Total sales in Kansas during registration: $ Previous Effective Date: NOTE: If total sales exceeded the amount registered, then an amendment fee of $100 plus an additional registration fee at 0.05% of the excess sales amount are required unless the maximum registration fee of $1,500 has been paid. 5. Aggregate offering price of securities to be offered in Kansas during extended year of registration: Offering Price No. of Aggregate Shares/Units Per Share/Unit Offering Price 6. Registration fee at 0.05% of the aggregate offering price above: $ (Minimum fee = $100 and Maximum fee = $1,500) 7. A CURRENT PROSPECTUS WITH CURRENT FINANCIAL STATEMENTS IS REQUIRED WITH RENEWAL APPLICATIONS (Attach explanation if not filed). / Representative of Issuer Signature / Date American LegalNet, Inc. www.USCourtForms.com