Form TEXAS PERMIT NO. 133.12 EXPIRATION DATE F.Y. END DATE Texas State Securities Board P.O. Box 13167 Austin, Texas 78711-3167 Renewal Application for Mutual Funds and Other Continuous Offerings Must be submitted with the applicable renewal fee. [This form must be filed at least one month before the expiration of a current permit.] 1. Name of Issuer. This name must be the same as that shown on Texas permit: 2. Principal address of Issuer: 3. Correspondent: Firm: Address: Telephone: ( ) 4. Describe any legal or administrative proceedingsof a material nature that have been institutedin whichtheIssuer, its advisor, or anyaffiliate wasnamedasa party. If you have not previously notified the State Securities Board of such proceedings, please attach a summary or copy of the pleadings. A-21 02-24-2004 American LegalNet, Inc. www.USCourtForms.com>>>> 2Form 133.12 AFFIDAVIT STATE OF COUNTY OF (
QAffiant
R) being duly sworn, deposes and says that heor sheis (title) of the above-named registrant,having full authority in said capacity to agree to the following undertakings as evidencedby his or her signature below in consideration of a renewed registration. The registrant agrees: (1) to file one copy of each new, revised, or amended prospectus as soon as it is available, with such copy marked to show changes; (2) to continueto file single copiesof all advertisingliteratureas requiredby the Texas Securities Act, Section 22; (3) to continue to file sales reports of securities sold and to maintain an adequate authorization based upon the rate of sales in Texas; (4) to terminate security sales immediately if a licensed Texas dealer is no longer authorized to make sales; and (5) to notify the State Securities Board immediatelyof any material adverse changein the registrant
Os plan of business or financial condition. Affiant further deposes and says that unless the State Securities Board has been notified otherwise, no legal or administrativeproceedingsof a material nature have been instituted in whichthe Issuer, its advisor, or anyaffiliate thereofwasa party sincepublicationof the Issuer
Os most recent prospectus. (Signature of Affiant) (Capacity) Subscribed and sworn to before me the day of , 20 ______ Notary Public in and for the County of State of (NOTARY SEAL) My commission expires: A-21A 02-24-2004 American LegalNet, Inc. www.USCourtForms.com