Nebraska Indefinite UIT Sales Report Nebraska Department of Banking & Finance http://www.ndbf.ne.gov Commerce Court 1230 "O" Street, Suite 400 PO Box 95006 Lincoln, NE 68509-5006 402-471-3445 For the 12-Month Period Beginning ________________ Ending ________________ (Please enter dates in mm/dd/yyyy format) State File Number Fund Address Contact Person Telephone Number Email Address Item A. B. Description Aggregate sales during period for which this report is filed. Fee for aggregate sales during the period for which this report is filed. (Item A times 0.1% or .001) Fee paid for registration. Additional fee due for this 12-month period. (Item B minus Item C) If this figure is negative, enter "0". There are no refunds or credits allowed. Amount (A) (B) C. D. (C) (D) If Item D is a positive figure, submit one check for the amount indicated in Item D. Page 1 of 1 Rev. 11/2004 UITslsrpt American LegalNet, Inc. www.FormsWorkFlow.com