Full name in which license is applied for (individual, partnership, corporation or limited liability company):Name of individual applicant completing form: � Instructionsfor use by the corporation or partnership. Each applicant must complete a separate form. Both sides must be completed and the I. � Work history - Title of position heldFromToName of employerAddress of employer American LegalNet, Inc. www.FormsWorkFlow.com � � Describe assetsAmountTotal assets$Describe liabilitiesAmountTotal liabilities$ III. Personal investment in business (a) � Amount to be invested by applicant: � Cash � $ � Equipment � $ � Goodwill � $ � Other � $ � � Total � $ � � � Yes � No � said business and the relationship, if any, of each person to the applicant. Amount � Source � Name � Address � Relationship � The applicant whose signature appears below represents under penalty of perjury that the foregoing statements are true and agrees Date � Signature of applicant American LegalNet, Inc. www.FormsWorkFlow.com