Form 133.36 Texas State Securities Board P.O. Box 13167 Austin, Texas 78711-3167 Request for Reduced Fees for Certain Persons Registered in Multiple Capacities Name: Address: Telephone: Date of Birth: Social Security Number: CRD Number: Applicant’s Dealer or name under which applicant will conduct business as a sole proprietor Dealer: Applicant’s Investment Adviser or name under which applicant will conduct business as a sole proprietor Investment Adviser: I, , certify that I am currently registered in Texas as either an agent of the above named dealer or as the above named sole proprietor dealer and that I am seeking to be or currently am registered in Texas as either an investment adviser representative of the above named investment adviser which has less than five investment adviser representatives or as the above named sole proprietor investment adviser who has less than five investment adviser representatives. I hereby request that the Securities Commissioner, pursuant to §115.8 and §116.8, grant a reduction in my registration fees. I further certify that I will notify the Securities Commissioner, within 30 days, of any cessation of dual registration or if any of the criteria enumerated in these Board Rules cease to be applicable. (Signature) Subscribed and sworn to before me the _________ day of _______________________, 2_ . Notary Public in and for the County of State of (NOTARY SEAL) My commission expires A-71 10-26-2006 American LegalNet, Inc. www.FormsWorkflow.com