Oregon Department of Consumer & Business Services Division of Finance & Corporate Securities Securities Section 350 Winter St. NE, Room 410, Salem, Oregon 97301-3881 Mailing address: P.O. Box 14480, Salem, OR 97309-0405 (503) 378-4140 Fax: (503) 947-7862 TTY: (503) 378-4100 www.oregondfcs.org Bond No.:______________ SURETY BOND (ORS 59.175(4)) Principal:________________________________________________________________________ _________ has applied to the Securities Section of the Oregon Department of Consum er & Business Services, Division of Finance and CorporateSecurities, for a license as an Oregon-based state investment adviser u nder ORS Chapter 59 and is required by ORS 59.175 to furnisha bond in the sum of $10,000, U.S. legal tender. Surety:________________________________________________________________________ ___________ is a corporation authorized by the insurance commissioner to transact in surance in the State of Oregon and is obligated to pay the sumof $10,000 to the State of Oregon for the use of said state and any pers on who has a cause of action against the principal.If the principal and its agents and employees comply with the provisions of Oregon Securities Law, this obligation shall be void. If theprincipal or its agents or employees violate any provisions of Oregon Se curities Law and fail to pay all damages suffered by any persondue to violation of Oregon Securities Law, the surety is obligated to pa y those damages suffered as a result of the violations up to $10,000.This bond becomes effective on__________________and shall remain in force until the Securities Section of the Department of Consumer & Business Services, Division of Finance and Corporate Securiti es, releases the surety from liability, or until the surety cancelsthis bond. The surety may cancel this bond and be relieved of further li ability hereunder by giving 30 days written notice to the principaland to the Securities Section of the Department of Consumer & Business S ervices, Division of Finance and Corporate Securities.This bond shall be a continuing obligation, and the liability of the sur ety for the aggregate of any and all claims that may arise shall notexceed $10,000. This surety and its heirs, personal representatives, successors, and ass igns, and the principal and its heirs, personal representatives,successors, and assigns bind themselves, jointly and severally, to the S tate of Oregon by this agreement. Principal:________________________________________________________________________ __ Address: ________________________________________________________________________ ___ City: __________________________________State: ____________________ZIP:______________ By (Typed name): ____________________________________________________________________ Signature:________________________________________________________________________ __ Date: ______________________ Surety: ________________________________________________________________________ ____ Address: ________________________________________________________________________ ___ City: __________________________________State: ____________________ZIP:______________ By (Attorney in fact/registered agent typed name): ________________________________________ Signature:________________________________________________________________________ __ Date: ______________________ American LegalNet, Inc.440-2014 (7/03COM) www.USCourtForms.com