1. (a) Name.
2. (b) Business address.
3. (c) Title of any position which the person holds with the applicant or with a parent of the applicant.
4. (d) Amount and types of equity securities of the applicant or of a parent of the applicant owned by the person and the person's associates.

In case the applicant is not a reporting company and any person is known to the applicant to be a 10 percent (including associates) equity security owner of the applicant, or in case the applicant has a parent which is not a reporting company and any person is known to the applicant to be a 10 percent (including associates) equity security owner of such parent, provide the following information with respect to each such 10 percent (including associates) equity security owner:

Note: Authority cited: Sections 321, 334 and 2032, Financial Code. Reference: Section 2032, Financial Code.

History

1. Amendment of Note filed 8-11-2015; operative 10-1-2015 (Register 2015, No. 33).