...................................................... : Index No. Form D-3 STATE OF NEW HAMPSHIRE No.______________ : Calendar No. DEPARTMENT OF STATE Rec'd____________ No license will be BUREAU OF SECURITIES REGULATION App'd____________ : issued until ALL Fee______________ JUDICIAL SUBPOENA Plaintiff(s) blanks in this form Granted__________ -against: are properly filled out. Personal Statement of Agent : 1. Name D.O.B. SS No. : (Give Full Name) 2. Business address Defendant(s) : (Town (Zip No.) . . . . . . . . . . . . . . . . . . . . . . . . (Street. and. Number .or .P.O. .Box). . . . . . . or City) ..... .. ..... . ... .. Current Home address 3. Have you read the New Hampshire law regulating the sale of securities? 4. Residence for past five years 5. Present occupation How long? THE PEOPLE OF THE STATE OF NEW YORK 6. Occupation for prior five years 7. If employed, give name and address of employer(s) TO 8. If member of firm, given firm name and names of partners 9. 10. 11. 12. What other business do you intend to carry on? GREETINGS: How many years experience in selling securities have you had? By whom WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before were you employed? In what other states have you ever applied for a Court securities license? , the Honorable at the located at County of 13. In what other states are you registered or licensed? in what , on the , 20 , at o'clock in the noon, and at have 14. In room states, if any,day of you been refused a securities license or any recessed have or adjourned date,to testify and give evidence as a witness in this action on the part of the to revocation or suspension? been subject 15. State briefly the general plan and method of selling securities, whether by person solicitation, correspondence or otherwise 16. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Name of whose behalf this and type issued for maximum penalty of $50 and all damages sustained as a the party onlast employer subpoena was of work aperformed result of your failure to comply. I desire to be licensed as an agent of (GIVE CORPORATE NAME) Witness, Honorable , one of the Justices of the 17. For the purpose of complying with the laws of New Hampshire relating to either Court or day of , 20 the offer in sale of County, securities in New Hampshire, I irrevocably appoint the Secretary of State of New Hampshire and the successors in such office, my attorney upon whom may be served any notice, process or pleading in any action or proceeding against me arising out of or in connection with the offer or sale must sign above and type name below) of the (Attorney of securities, or out violation, or alleged violation, of the laws of New Hampshire. I consent that any such action or proceeding against me may be commenced in any court of competent jurisdiction and proper venue by service of process upon the appointee as if I were a Attorney(s) for resident of, and had been lawfully served with process, in New Hampshire, I request that a copy of any notice, process or pleading served hereunder be mailed to my current residential address as reflected in this form or any amendment thereto. Signed Notarized: STATE OF COUNTY OF Subscribed and sworn to before me this Notary Public Office and P.O. Address No.: day of Telephone , Facsimile No.: E-Mail Address: Mobile Tel. No.: Date of expiration of Commission American LegalNet, Inc. www.USCourtForms.com sec. form D-3 v1.1