STATE OF DELAWARE
         DEPARTMENT OF FINANCE            BUSINESS COLLECTION INFORMATON STATEMENT
         DIVISION OF REVENUE      [If you need additional space, please attach a separate sheet
         820 N. FRENCH STREET     with your Business Name & Federal Employer Identification No.
         WILMINGTON, DE 19801     or Social Security No., if applicable]
1) NAME & ADDRESS OF BUSINESS:            2) BUSINESS PHONE NUMBER:
                                          3) CHECK APPROPRIATE BOX:
                                          SOLE PROPRIETOR        OTHER (SPECIFY):
                                          PARTNERSHIP
                                          CORPORATION
4) NAME & TITLE OF PERSON COMPLETING THIS 5) FEDERAL EMPLOYER ID   6) TYPE OF BUSINESS:
   FORM:                                  NO. OR SOCIAL SECURITY
                                          NO. [IF APPLICABLE]:

7) INFORMATION ABOUT OWNER, PARTNERS, OFFICERS, MAJOR SHAREHOLDERS, ETC.:
                    EFFECTIVE                       PHONE      SOCIAL SECURITY     TOTAL SHARES
NAME & TITLE                          HOME ADDRESS
                    DATE                            NUMBER       NUMBER            OF INTEREST

SECTION 1.                        GENERAL FINANCIAL INFORMATION
8) LATEST FILED INCOME TAX        FROM:       TAX YEAR ENDED:    NET INCOME BEFORE TAXES:
   RETURN
9) BANK ACCOUNTS: (List all types of accounts, including Payroll and General, Savings,
   Certificates of Deposits, etc.)
                                                    TYPE OF        ACCOUNT
NAME OF INSTITUTION               ADDRESS           ACCOUNT        NUMBER          BALANCE

 10)  BANK CREDIT AVAILABLE: (Lines of Credit, etc.)

                                                    CREDIT     AMOUNT    CREDIT       MONTHLY
NAME OF INSTITUTION                                 LIMIT      OWED      AVAILABLE    PAYMENTS
                                  ADDRESS

11) LOCATION, BOX NUMBER AND CONTENTS OF ALL SAFE DEPOSIT BOXES RENTED OR ACCESSED:

SECTION 1 (CONT’D)             GENERAL FINANCIAL INFORMATION

12) REAL PROPERTY
  BRIEF DESCRIPTION & TYPE OF OWNERSHIP  ADDRESS (INCLUDE COUNTY & STATE)
A.

B.

C.

D.

13) LIFE INSURANCE POLICIES OWNED WITH BUSINESS AS BENEFICIARY:

                                        POLICY                      FACE     AVAILABLE
  NAME INSURED     COMPANY              NUMBER                 TYPE AMOUNT   LOAN VALUE

                                             TOTAL
                                        (Enter in Item 19)
 14) ADDITIONAL INFORMATION REGARDING FINANCIAL CONDITION:  (COURT PROCEEDINGS, BANKRUPTCIES
     FILED OR ANTICIPATED, TRANSFERS OF ASSETS FOR LESS THAN FULL VALUE, CHANGES IN MARKET
     CONDITIONS, ETC. INCLUDE INFORMATION REGARDING COMPANY PARTICIPATION IN TRUSTS, ESTATES,
     PROFIT-SHARING PLANS, ETC.

15) ACCOUNTS/NOTES RECEIVABLE (Include Loans to Stockholders, Officers, Partners, Etc.):

  NAME                         ADDRESS   AMOUNT DUE                 DUE DATE STATUS

                                        $

                        TOTAL
                                        $
                   (Enter in Item 18)

SECTION II.                               ASSETS & LIABILITY ANALYSIS
                   CURRENT    LIABILITIES EQUITY IN AMOUNT OF NAME & ADDRESS OF        DATE    DATE OF
     DESCRIPTION   MKT. VALUE BALANCE DUE   ASSET   NO. PYMT  LEIN/NOTE HOLDER/OBLIGEE PLEDGED   FINAL
                                                                                                 PYMT
         (a)       (b)        (c)         (d)       (e)              (f)               (g)     (h)
16) CASH ON HAND

17) BANK ACCOUNTS

18) ACCOUNTS/NOTES
     RECEIVALBLE
19) LIFE INSURANCE
   LOAN VALUE
20)               a
                  .
                  b
REAL              .
PROPERTY          c
                  .
                  d
                  .
            a.
21)
VEHICLES    b.
MODEL,
YEAR, &
LICENSE)    c.

22)         a.
MACHINERY
   &        b.
EQUIPMENT
(SPECIFY)   c.

23)         a.

MERCHANISE  b.
IVENTORY
(SPECIFY)   c.

24)        a.
OTHER
ASSETS
(SPECIFY) b.

            a.
25)
           b.

           c.
OTHER
LIABILITIES d.
[INCLUDE
NOTES &   e.
JUDGMENTS
           f.

           g.

            h.
26) TAXES OWED

27) TOTAL

SECTION III)                        INCOME AND EXPENSE ANALSIS

THE FOLLOWING APPLIES TO INCOME & EXPENSES   ACCOUNTING METHOD USED:
DURING THE PERIOD                 TO

               INCOME                                             EXPENSES

28)  GROSS RECEIPTS FROM SALES, SERV.,ETC. $ 34)   MATERIAL PURCHASED                              $
                                             35)   NET WAGES AND SALARIES
29)  GROSS RENTAL INCOME
                                             36)   RENT
30)  INTEREST
                                             37)   INSTALLMENT PAYMENTS
31)  DIVIDENDS
                                             38)   SUPPLIES
32)  OTHER INCOME (SPECIFY)
                                             39)   UTILITIES/TELEPHONE

                                             40)   GASOLINE/OIL

                                             41)   REPAIRS AND MAINTENANCE

                                             42)   INSURANCES

                                             43)   CURRENT TAXES

                                             44)   OTHER (SPECIFY)

                                           $ 45) TOTAL

33) TOTAL                                    46) NET DIFFERENCES

                                             CLARIFICATION
          UNDER PENALTIES OF PERJURY, I DECLARE THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF, THIS
          STATEMENT OF ASSETS, LIABILITIES, AND OTHER INFORMATION, IS TRUE, CORRECT, AND COMPLETED.
YOUR SIGNATURE                               TITLE                                                 DATE