Model Accredited Investor Exemption Uniform Notice of Transaction Notice of Sale of Securities pursuant to Accredited Investor Exemption 1. Issuer Name: Address: Phone Number: 2. Form of Organization (check one) Corporation Unincorporated Association Limited Liability Company Limited Partnership Other (specify) Issuers state or jurisdiction of incorporation or organization Date of incorporation or organization 3. Officers and Directors (or persons acting in a similar capacity) Names, Business Addresses, and Business Phone Numbers 4. This offering: Price per security Number of securities Aggregate dollar Description of Security to be offered amount of offering Debt Equity (common or preferred) Convertible Security Partnership Interests Other (Specify) >>>> 25. Description of Business 6. Name of any Broker-Dealer who has solicited or intends to solicit purchasers in this state. Business Address By filing this Notice of Transaction, the issuer of these securities understands that: (1) Sales of securities shall be made only to persons whom the issuer reasonably believes are accredited investors as defined in 17CFR 230.501(a). (2) The issuer is not an issuer in the development stage that either has no specific business plan or purpose or has indicated that its business plan is to engage in a merger or acquisition with an unidentified company or companies, or other entity or person. (3) The issuer reasonably believes that all purchasers are purchasing for investment and not with the view to or for sale in connection with a distribution of the security. Any resale of a security sold in reliance on this exemption within 12 months of sale shall be presumed to be with a view to distribution and not for investment, except a resale pursuant to an effective registration statement or to an accredited investor pursuant to an available exemption. The undersigned represents that the issuer is familiar with the conditions that must be satisfied to be entitledto the Accredited Investor Exemption of the state in which this notice is filed and understands that the issuerclaiming the availability of this exemption has the burden of establishing that these conditions have been satisfied. The issuer has read this notification and knows the contents to be true and has duly caused this notice to be signed on its behalf by the undersigned duly authorized person. Issuer (Print or Type) Signature DateName (Print or Type) Title (Print or Type)