Out Of State Filing Information

Please designate the states in which the forms in this submission will be delivered
(Choose "all except NY" unless use is restricted to specific states):
All except NY Alabama Alaska Arizona
Arkansas California Colorado Connecticut
Delaware District of Columbia Florida Georgia
Hawaii Idaho Illinois Indiana
Iowa Kansas Kentucky Louisiana
Maine Maryland Massachusetts Michigan
Minnesota Mississippi Missouri Montana
Nebraska Nevada New Hampshire New Jersey
New Mexico North Carolina North Dakota Ohio
Oklahoma Oregon Pennsylvania Rhode Island
South Carolina South Dakota Tennessee Texas
Utah Vermont Virginia Washington
West Virginia Wisconsin Wyoming Other:
Other: Other: Other: Other:
Explanation: