State of Washington Department of Financial Institutions Securities Division P.O. Box 9033 Olympia, WA 98507-9033 360-902-8760 ANNUAL NOTICE OF CLAIM OF EXEMPTION PURSUANT TO RCW 19.100.030(4) (a), (b) (i) and (c) Type or print application Initial Application ($100 Fee) Renewal Application ($100 Fee) 1. Name of Franchisor: (Subfranchisor -- if applicable): 2. Name of Franchisee: Re-Application ($100 Fee) Amendment (No Fee) File No. 3. Address of Claimant (and mailing address, if different): 4. Telephone Number: 5. Name of person to whom communications regarding this notice should be sent: Address: Telephone Number: 6. Description of business to be franchised: SC-610-259 FRAN.CLAIM OF EXEMPTION (N/7/91)M Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com The undersigned franchisor represents that it: (1) shall provide prospective purchasers in the state of Washington an offering circular, that complies with guidelines adopted by the director, at least ten business days prior to the signing of an agreement or receipt of consideration; (2) (check the applicable box) has a net worth on a consolidated basis, according to its most recent audited financial statement, of not less than $5,000,000; or has a net worth of $1,000,000 according to its most recent audited financial statement and is at least 80% owned by a corporation which has a net worth on a consolidated basis, according to its most recent audited financial statement, of not less than $5,000,000; (3) (check the applicable box) has had at least 25 franchisees conducting business at all times during the five year period immediately preceding the offer or sale; or has conducted business which is the subject of the franchise continuously for not less than five years preceding the offer or sale; or is owned 80% or more by a corporation which has had at least 25 franchises conducting business continuously for not less than five years immediately preceding the offer or sale; or is owned 80% or more by a corporation which has conducted business which is the subject of the franchise continuously for not less than five years preceding the offer or sale; (4) requires a minimum investment of more than $100,000; and (5) has not been found by a court to be in violation of state or federal franchising or consumer protection laws in the past seven years. Attach a copy of the franchisor' most recent audited financial statements (and, if applicable, those of any s corporation upon whose financial statements the franchisor is relying to qualify for the exemption). Do not send a copy of the offering circular or agreement unless requested to do so. This claim of exemption will be effective for a period of twelve months from the date it is granted effectiveness. A renewal notice should be filed ten business days prior to the expiration of the effective period. Certified this _________________ day of ____________________, 20____________ by___________________________________________________________________ Signature Type or Print Name and Title for Type or Print Name of Franchisor SC-610-259 FRAN.CLAIM OF EXEMPTION (2/96) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com