A. BASIC IDENTIFICATION DATA 2. Enter the information requested for the following: l Each promoter of the issuer, if the issuer has been organized within the past five years; l Each beneficial owner having the power to vote or dispose, or direct the vote or disposition of, 10% or more of a class of equity securities of the issuer. l Each executive officer and director of corporate issuers and of corporate general and managing partners of partnership issuers; and l Each general and managing partner of partnership issuers. Check Box(es) that Apply: Promoter Beneficial Owner Executive Officer Director General and/or Managing Partner ___________________________________________________________________________________________________________________________________ Full Name (Last name first, if individual) __________________________________________________________________________________________________________________________________ Business or Residence Address (Number and Street, City, State, Zip Code) Check Box(es) that Apply: Promoter Beneficial Owner Executive Officer Director General and/or Managing Partner ___________________________________________________________________________________________________________________________________ Full Name (Last name first, if individual) _____________________________________________________________________________________________________________________________________ Business or Residence Address (Number and Street, City, State, Zip Code) Check Box(es) that Apply: Promoter Beneficial Owner Executive Officer Director General and/or Managing Partner _________________________________________________________________________________________________________________________________ Full Name (Last name first, if individual) ______________________________________________________________________________________________________________________________________ Business or Residence Address (Number and Street, City, State, Zip Code) Check Box(es) that Apply: Promoter Beneficial Owner Executive Officer Director General and/or Managing Partner ____________________________________________________________________________________________________________________________________ Full Name (Last name first, if individual) __________________________________________________________________________________________________________________________________ Business or Residence Address (Number and Street, City, State, Zip Code) Check Box(es) that Apply: Promoter Beneficial Owner Executive Officer Director General and/or Managing Partner ___________________________________________________________________________________________________________________________________ Full Name (Last name first, if individual) __________________________________________________________________________________________________________________________________ Business or Residence Address (Number and Street, City, State, Zip Code) Check Box(es) that Apply: Promoter Beneficial Owner Executive Officer Director General and/or Managing Partner ___________________________________________________________________________________________________________________________________ Full Name (Last name first, if individual) __________________________________________________________________________________________________________________________________ Business or Residence Address (Number and Street, City, State, Zip Code) Check Box(es) that Apply: Promoter Beneficial Owner Executive Officer Director General and/or Managing Partner ___________________________________________________________________________________________________________________________________ Full Name (Last name first, if individual) __________________________________________________________________________________________________________________________________ Business or Residence Address (Number and Street, City, State, Zip Code) __________________________________________________________________________________________________________________________________ (Use blank sheet, or copy and use additional copies of this sheet, as necessary) 2 of 9 2002 © American LegalNet, Inc.