PRE-NEED FUNERAL CONTRACT SALES ANNUAL REPORT NORTH DAKOTA SECURITIES DEPARTMENT SFN 51531 (Rev. 09-2002) FORM P-2 Securities Department 600 E Boulevard Ave Bismarck ND 58505 (701) 328-2910 www.ndsecurities.com Filing Fee $15.00 Calendar Year: A: Name of funeral establishment or cemetery association. B: Address of funeral establishment or cemetery association. C: Telephone number of funeral establishment or cemetery association. D: Name of manager or operator. E: The total number of pre-need funeral service contracts entered into during the calendar year covered by this report: F: The total in dollars of all funds received in payment for pre-need funeral service contracts for the calendar year covered by this report, do not include interest earned: $ G: The total dollars released by a financial institution during the calendar year covered by this report prior to the death of the person for whose benefit the funds were paid: $ H: The total in dollars released by a financial institution during the calendar year covered by this report to the entity named in ''A'' above: $ I: The total in dollars of all funds received since July 1, 1973, which are undrawn, unexpended and on deposit in a financial institution: $ J: On the enclosed sheet provide legibly the following information for each pre-need funeral service contract entered into the calendar year covered by this report: (1) The name of the purchaser; (2) The name of the beneficiary (3) Amount paid by the purchaser; (4) Amount deposited by the entity name in ''A'' above; (5) Date of the contract; and (6) Name and complete mailing address of the financial institution in which the consideration was deposited. *Footnote - The term ''financial institution'' means a bank, credit union, savings and loan association or trust company. (Date) (Signature) American LegalNet, Inc. www.USCourtForms.com