Form 133.4 Texas State Securities Board P.O. Box 13167 Austin, Texas 78711-3167 Military Spouse Request for Expedited Review (§115.18 or §116.18) 1. Name of Applicant: 2. Application Type (check all that apply): G Dealer G Investment Adviser 3. SSN No. of the Applicant: 5. Agent Investment Adviser Representative CRD No. of the Applicant (if applicable): 4. G G Name of Employer: CRD or IARD No. of the Employer, if applicable: 6. Applicant (check all that apply): G is the spouse of an individual serving on active duty as a member of the armed forces of the United States assigned to a military unit headquartered in Texas. G holds a current registration issued by another state, the District of Columbia, or a territory of the United States. Please list all such jurisdictions where the applicant holds a comparable current registration: G was previously registered in Texas within the last five years preceding the date of the application for registration for which expedited review is requested. G was living in another state for at least six months during which time the applicant’s previous registration in Texas expired. The undersigned affirms that to the best of his or her knowledge, information, and belief the statements made on this form are true. Date: (Signature) (Printed name) 06-13-2012 American LegalNet, Inc. www.FormsWorkFlow.com