CSCL/SEC-0553 (/)Michigan Department of Licensing and Regulatory AffairsCorporations, Securities & Commercial Licensing Bureau DivisionSECURITIESP.O. Box 30018, Lansing, MI 48909 FOR OFFICE USE ONLY Approved By:Date Approved:License NumberPERSONAL BALANCE SHEET 517-241-6345www.michigan.gov/securities : Name AddressE-mail Address CityStateZip CodeTelephone Number CRD Number Date of Balance Sheet / / mmddyy CURRENT ASSETS 1. Cash . Primary Residence 3. 2. Checking/Savings CURRENT LIABILITIES . . axes Payable: . . . CERTIFICATIONI certify that the statements in this document are true and complete. I understand that any omitted statement, misrepresentation, or fraud may be cause fordenial of my application, disciplinary action, or may be punishable by law. Signature Date . ... . . . American LegalNet, Inc. www.FormsWorkFlow.com CSCL/SEC-0553 (/1) Michigan Department of Licensing and Regulatory Affairs Corporations, Securities & Commercial Licensing Bureau Securities and Audit Division SECURITIES P.O. Box 30018, Lansing, MI 48909 517-241-6345www.michigan.gov/securitiesPERSONAL BALANCE SHEET INSTRUCTIONS Line 10 through Line 24: Liabilities: A liability is a financial debt or obligation that arise during the course of operation and are settled over time through the transfer of economic benefits including money, goods or services. Your liabilities should be reported as either current or long-term, based upon the following determination: American LegalNet, Inc. www.FormsWorkFlow.com