Schedule A of Page 1Form LT-1 Applicant: Date: (For individuals applying for a license to sell living trusts) 1. Applicant firm: (See Form LT-1, Item 1) 2. Individuals full name for whom this Social Security Number: Schedule is being completed: 3. Residence of individual:(Number and Street) (City) (State) (Zip) If this individual is affiliated with an Investment Advisor Firm other t han the Applicant Firm, complete the following: 4. Name of Firm: 5. Principal place of business: (Number and Street) (City) (State) (Zip) 6. Mailing Address: (Number and Street or PO Box) (City) (State) (Zip) (If different from Item 5) 7. Telephone number of Firm: (Area Code) (Number) A completed Schedule A is required for each individual who will offer or sell living trusts under the license of the applicant on Form LT-1. Pursuant to 6.1 2.1203, ARM, the applicant must amend this form within thirty (30) days of the occu rrence of any change in the information contained on Form LT-1 or its attached schedul es. Orig. 10/97 American LegalNet, Inc. www.USCourtForms.com