EFTA01121458.pdf

FR U-I OMB No. 7100-0115 Approval expires January 31. 2010 BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM Statement of Purpose for an Extension of Credit Secured by Margin Stock (Federal Reserve Form U-1) JPMorgan Chase Bank, N.A. Name of Bank This form is required by law (15 U.S.C. 78g and 78w: 12 CFR 221). to gather and maintain data in the required form and to review instructions and complete the information collection. The Federal Reserve may not conduct or sponsor, and an Send comments regarding this burden estimate or any other organization (or a person) is not required to respond to. a collection aspect of this collection of information, including suggestions for of information unless it displays a currently valid OMB control reducing this burden to: Secretary. Board of Governors of the number. Federal Reserve System. 20th and C Streets. N.W., Washington. Public reporting burden for this collection of information is DC 20551: and to the Office of Management and Budget. estimated to average 10 minutes per response. including the time Paperwork Reduction Project (7100.0019).Washington, DC 20503. Instructions 1. This form must be completed when a bank extends credit in excess of $100,000 secured directly or indirectly. in whole or in part. by any margin stock. 2. The term "margin stock" is defined in Regulation U (12 CFR 221) and includes. principally: (1) stocks that are registered on a national securities exchange or any over-the-counter security designated for trading in the National Market System: (2) debt securities (bonds) that are convertible into margin stocks; and (3) shares of most mutual funds. 3. Please print or type (if space is inadequate. attach separate sheet). Part I To be completed by borrower(s) 1. What is the amount of the credit being extended? $ 2. Will any part of this credit be used to purchase or carry margin stock? ❑ Yes ❑ No If the answer is "no," describe the specific purpose of the credit. I (We) have read this form and certify that to the best of my (our) knowledge and belief the information given is true. accurate, and complete, and that the margin stock and any other securities collateralizing this credit are authentic, genuine. unaltered, and not stolen, forged. or counterfeit. Signed: SOUTHERN FINANCIAL, LLC 5/15/2013 Borrower and/or Pledgor's signature Date Jeffrey Epstein, Manager Print or type name This form should not be signed if blank. A borrower who falsely certifies the purpose of a credit on this form or otherwise willfully or intentionally evades the Regulation U will also violate Federal Reserve Regulation X, - Borrowers of Securities Credit." EFTA01121458  FR U.I Page 2 of 2 Part II To be completed by bank only if the purpose of the credit is to purchase or carry margin securities (Part 1(2) answered "yes") 1. List the margin stock securing this credit: do not include debt securities convertible into margin stock. The maximum loan value of margin stock is 50 per cent of its current market value under the current Supplement to Regulation U. Date and source No. of Market price Total market Issue of valuation Shares per share (See note below) Value per issue 2. List the debt securities convertible into margin stock securing this credi . The maximum loan value of such debt securities is 50 ercent of the current market value under the current Supplement to Regulation U. source Market price Date and Total market Principal Issue of valuation amount value per issue (See note below) 3. List other collateral including non-margin stock securing this credit. Market price Date and source Describe briefly of valuation Good faith loan value (See note below) Note: Bank need not complete 'Date and source of valuation' if the market value was obtained horn regularly published information in a journal of general circulation or an automated quotation system. Part III To be signed by a bank officer in all instances. I am a duly authorized representative of the bank and understand to have examined the written consent of the registered owner that this credit secured by margin stock may be subject to the to pledge such securities. I further certify that any securities credit restrictions of Regulation U. I have read this form and any that have been or will be physically delivered to the bank in attachments. and I have accepted the customer's statement in connection with this credit have been or will be examined, that Part I in good faith as required by Regulation U': and I certify that all validation procedures required by bank policy and the to the best of my knowledge and belief, all the information given Securities Exchange Act of 1934 (section 17(f), as amended) is true. accurate. and complete. I also certify that if any securities have been or will be performed: and that I am satisfied to the that directly secure the credit are not or will not be registered in best of my knowledge and belief that such securities are the name of the borrower or its nominee. I have or will cause genuine and not stolen or forged and their faces have not been altered. Signed: Date Bank officer's signature Title Print or type name • To accept the customer's statement in good faith. the duly authorized representative of the creditor must be alert to the circumstances surrounding the credit and. it in possession of any information that would cause a prudent person not to accept the statement without inquiry, must have investigated and be satisfied Mal the statement is truthful. Among the facts which would require such investigation is receipt of the statement through the mail or from a third party. This form must be retained by the lender for three years after the credit is extinguished. EFTA01121459