STATE OF WASHINGTON Department of Financial Institutions Securities Division PO Box 9033 Olympia, WA 98507-9033 360-902-8760 REGISTRATION BY QUALIFICATION 1. Name and address of registrant _________________________________________ ___________________________ 2. Name and address of issuer _____________________________________________ __________________________ ________________________________________________________________________ ______________________ 3. Short description of securities to be qualified: 4. Number of securities to be offered in Washington _______________________ _______________________________ 5. Number of securities to be offered in all states _______________________ _________________________________ 6. Maximum price per security _______________________________________________________________________ 7. Fee ($100.00 for the first $100,000 of initial issue, or portion thereo f in this state, based on the offering price, plus 1/20 of 1% for any excess over $100,000 which are to be offered dur ing that year.) ________________________________________________________________________ ______________________ (NOT LESS THAN $100.00) 8. Fiscal year ends _______________________________________________________ _________________________ 9. Name, address, and phone number of person to contact who is responsible for this filin g _______________________ ________________________________________________________________________ ______________________ _____________________________________________ By: _____________________________________________ STATE OF WASHINGTON County of ______________ _____________________________________________________________, being fir st sworn, deposes and says: I have been authorized by the registrant to execute and file the foregoing stat ement. I have read the statement and the exhibits filed with it, and the facts stated in the statement and in the exhibits are true to the best of my knowledge, information and belief. _____________________________________________ AFFIANT Subscribed and sworn to before me this ________ day of __________, 19 ____ _____________________________________________ NOTARY PUBLIC American LegalNet, Inc.SC-610-004 REG. BY QUALIFICATION (R/5/91)M Page 1 of 3 www.USCourtForms.com>>>> 2 EXHIBITS Pursuant to RCW 21.20.210, Laws of 1959, the following information must be filed by way of exhibits numbered and captioned as follows. Exhibits may not be incorporated by reference to t he offering circular or a previous filing. Exhibit 1 Form of Organization of Issuer: Ltd. Partnership Corporation Unincorporated Association Other _____________________Exhibit 2 Place and date of organization. Exhibit 3 Submit a copy of charter documents: (Articles in Incorporation, Partner ship agreement, etc.) Exhibit 4 Submit a copy of minutes of corporation that apply to proposed security issue. Exhibit 5 Give a statement of the general character and location of the business. Exhibit 6 Give a description of the issuers physical properties and equipment. Exhibit 7 Name(s) and address(s) of subsidiaries. Exhibit 8 List the name and address of every director and officer of issuer, or pe rson occupying similar status (i.e., general partners) Exhibit 9 Give the principal occupation for the past five years of all persons lis ted in exhibit 8 and the amount of securities of the issuer held by him or her. Exhibit 10 Give the total direct or indirect remuneration paid to all persons liste d in Exhibit 8 within the past 12 months and the estimated amount to be paid in the next 12 month. Exhibit 11 List all stockholders, owning of record (or beneficially if known) 10% or more of the outstanding shares of the issuer and the amount. Exhibit 12 List all promoters not otherwise included in the preceding exhibits, if the company was organized within the past five years. Exhibit 13 List the amount of securities held by the persons listed in the Exhibit 12 and the amount or remuneration paid to such persons within the past 12 months or estimate to be paid in the next 12 months. Exhibit 14 Show the capitalization and long-term debt (on current and pro-forma ba sis) of the issuer and any subsidiary. Exhibit 15 Give a description and the number of each security outstanding of the is suer and any subsidiary. Exhibit 16 Give the basis on which the aforementioned securities were issued (state the exemption in section or give prior registration number). Exhibit 17 State whether any other securities are being offered other than under th is registration statement. If so, state the basis of such offering. Exhibit 18 State whether there are any outstanding obligations to issue any securit ies. If yes, state the consideration to be paid for such securities. Exhibit 19 State the amount and kind of consideration (whether in the form of cash , physical assets, services, talents, goodwill, or anything else) for which the issuer or any subsidiary has issued any of the securities within the past five years. Exhibit 20 If any of the securities are to be sold on an other-than-cash basis, sta te the terms and conditions of such proposed sales. Exhibit 21 State the aggregate underwriting and selling commission in dollar amount and as percentage of offering. American LegalNet, Inc.SC-610-004 REG. BY QUALIFICATION (R/5/91)M Page 2 of 3 www.USCourtForms.com>>>> 3Exhibit 22 State the estimated amount of other selling expenses including legal, en gineering, and accounting expenses to be incurred by the issuer in connection with the offering in dollar a mount and as a percentage of offering.Exhibit 23 Submit a copy of the underwriting or selling agreement. Exhibit 24 Submit a description of the plan of distribution of any securities which are to be offered other than through an underwriter. Exhibit 25 State the name and address of every underwriter or recipient of a finder s fee. Exhibit 26 State the estimated cash proceeds to be received by the issuer from the offering. Exhibit 27 State the purposes for which the proceeds are to be used and the amount to be used for each purpose and the order of priority in which the proceeds will be used for the purpose s stated. Exhibit 28 State the amounts of any funds be raised from other sources to achieve t he purposes stated in Exhibit 34, and the sources of such funds. Exhibit 29 If any part of the proceeds is to be used to acquire any property (incl uding goodwill) other than in the ordinary