STATE OF WASHINGTON FOR VALIDATION ONLY Department of Financial Institutions MORTGAGE BROKER-DEALER Securities Division P.O. Box 9033 QUARTERLY REPORT FORM Olympia, WA 98507-9033 Telephone: (360) 902-8760 Fax: (360) 586-5068 Permit Holder: Permit No.: Permit Amount: Permit Effective Date: Permit Expiration Date: 1. This report is for the quarter ended: 2. Securities sold under CURRENT permit: Dollar Amount This quarter: Prior quarters: Total to Date: Attach a separate document that lists the amount purchased by each inves tor and their individual names. 3. Financial Statements: Pursuant to WAC 460-60A-010 and WAC 460-60A-025, attach a balance sheet and profit and loss statement, or Form 10-Q, prepared in accordance with generally accepted accounting principles for the period being reported. 4. Offering Circular or Prospectus (Check One): No material changes since the last offering circular was filed. Material changes have occurred requiring revision of the last offering c ircular filed. A copy of the current offering circular, showing red-lined changes, is enclosed with t his report for approval. 5. I certify that all the above statements and data are true, correct, and complete. Date: Signature: Title: Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com>>>> 2A FILING FEE OF $10.00 MUST BE SUBMITTED WITH THIS REPORT. MAKE CHECKS PAYABLE TO WASHINGTON STATE TREASURER. General Reminders Notice of Changes: In accordance with WAC 460-33A-125, upon any material change in the info rmation contained in the application for registration, the mortgage broker-deale r must promptly file an amendment to such application setting forth the changed informat ion. In addition, mortgage broker-dealers shall notify the Division of the employment of a new sales agent and of the termination of any agent in Washington, by completing a NASD Form U-4 or U-5, respectively, with the Division within 21 days or 30 days, r espectively, after the event occurs. Advertising: Pursuant to WAC 460-33A-075, prior to disseminating any advertising mate rials to the public, every mortgage broker-dealer must file the proposed advertising materials with the Division five days prior to use. Financial In connection with WAC 460-33A-110, mortgage broker-dealers must file an nually Statements: audited financial statements prepared in accordance with generally accep ted accounting principles within 90 days after the close of the period. In addition, m ortgage broker- dealers must file quarterly financial statements complete with footnotes and prepared in accordance with generally accepted accounting principles pursuant to WAC 460-60A- 010 and WAC 460-60A-025. Quarterly financial statements are not require d to be audited and must be submitted within 30 days of the close of the period in accordance with WAC 460-60A-035. Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com