Common use of Form of Ownership Clause in Contracts

Form of Ownership. Please indicate the form of ownership you desire. ________ Individual or entity or trust (one signature required, unless otherwise required by organization documents) ________ Joint Tenants with right of survivorship (both parties must sign) ________ Tenants-in-Common (all parties must sign) ________ Community Property (one signature required if Shares and Warrants held in one name, i.e., ranging spouse; two signatures required if Shares and Warrants are held in both names) ______________________________________________________________ Please PRINT here the exact name(s) in which you wish the Shares and Warrants registered. ACCEPTED: BOSTON OMAHA CORPORATION By: ________________________________ Name: Xxxx X. Xxxxx Title: President Dated: June ___, 2015 SIGNATURE PAGE FOR PARTNERSHIP/LIMITED LIABILITY COMPANY INVESTORS Note: The partner(s), manager(s) or member(s) authorized to bind the partnership or limited liability company must sign and include a copy of the partnership, limited liability company or operating agreement, including any amendments. The agreement should include the date of formation of the partnership or limited liability company, a list of all partners or members (and managers, if any), the appropriate language authorizing this type of investment and the power of the general partner(s) or member(s) or manager(s) to sign on behalf of such entity. __________________________________________ Name of Partnership/Limited Liability Company (please print or type) By: _______________________________________ (Signature of a General Partner/Manager/Member) Taxpayer Identification No.: ___________________________ E-mail Address: Principal Business Offices: ____________________________________ ____________________________________ ____________________________________ ____________________________________ Mailing Address ____________________________________ (if different): ____________________________________ ____________________________________ ____________________________________ Attention: ____________________________ Executed at _____________________, ____________________ City State this _______ day of June, 2015. EXHIBIT A PURCHASER QUESTIONNAIRE INSTRUCTIONS TO PURCHASER QUESTIONNAIRE BOSTON OMAHA CORPORATION This questionnaire must be completed by all investors. In order to subscribe as an investor for this offering, you must complete this questionnaire. If you have any questions concerning any of the information called for, or questions concerning whether you qualify as an accredited investor, you may ask your lawyer, accountant or representatives of the Company for assistance. If this Questionnaire is being completed for married individuals subscribing as joint tenants or tenants-in-common, it must be completed by the person making the investment decision on behalf of the joint tenants or tenants-in-common. If joint tenants or tenants-in-common are not married or are each making the investment decision if married, a separate questionnaire must be completed for each joint tenant or tenant-in-common.

Form of Ownership. Please indicate the form of ownership you desire. ______ ___ Individual or entity or trust (one signature required, unless otherwise required by organization documents) ________ Joint Tenants with right of survivorship (both parties must sign) ________ Tenants-in-Common (all parties must sign) ________ Community Property (one signature required if Common Shares and Warrants held in one name, i.e., ranging spouse; two signatures required if Common Shares and Warrants are held in both names) ______________________________________________________________ Please PRINT here the exact name(s) in which you wish the Common Shares and Warrants registered. ACCEPTED: BOSTON OMAHA CORPORATION By: ________________________________ Name: Xxxx Axxx X. Xxxxx Title: President Co-Chief Executive Officer Dated: June ___________ ___, 2015 2016 SIGNATURE PAGE TO SUBSCRIPTION AGREEMENT FOR PARTNERSHIP/LIMITED LIABILITY COMPANY INDIVIDUALS If the Common Shares are to be owned by joint tenants or tenants-in-common, all tenants must sign. If the Common Shares are to be owned as community property, one signature is required if they are to be held in one name and two signatures are required if they are to be held in both names. Investor #1 Investor #2 __________________________ __________________________ Signature Signature __________________________ __________________________ Social Security Number Social Security Number __________________________ __________________________ Print Name Print name __________________________ __________________________ E-mail Address E-mail Address Residence Address: Residence Address: __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ Executed at: Executed at: __________________________ __________________________ City City __________________________ __________________________ State State this __ day of ________, 2016. this __ day of ________, 2016. Mailing Address (if different from residence address): __________________________ __________________________ __________________________ SIGNATURE PAGE TO SUBSCRIPTION AGREEMENT FOR CORPORATE INVESTORS Note: The partner(s), manager(s) or member(s) An officer duly authorized to bind the partnership or limited liability company corporation must sign and include a copy copies of the partnership, limited liability company corporation's articles or operating agreement, including certificate of organization or incorporation and bylaws (and any amendments. The agreement should include ) and corporate resolutions or other documents authorizing the date of formation of the partnership or limited liability company, a list of all partners or members (and managers, if any), the appropriate language authorizing this type of investment and the power of the general partner(s) or member(s) or manager(s) officer to sign on behalf of such entitythe corporation, which copies must be certified by the corporate secretary or clerk as true and correct. _____________________________________________ Exact Name of Corporation (please print or type) By: __________________________________________ Signature of Authorized Officer _____________________________________________ Signing Officer's Name and Title (please print or type) Taxpayer Identification No.: _______________________ E-mail Address: _________________________________ Address of Principal Corporate Offices: ____________________________________ ____________________________________ ____________________________________ ____________________________________ Mailing Address ____________________________________ (if different): ____________________________________ ____________________________________ ____________________________________ Attention: ___________________________ Executed at ____________________________, _________________________ City State this _______ day of ___________, 2016. SIGNATURE PAGE TO SUBSCRIPTION AGREEMENT FOR PARTNERSHIP/LIMITED LIABILITY COMPANY INVESTORS Note: A partner, manager or member duly authorized to bind the partnership or limited liability company must sign. ______________________________________________ Exact Name of Partnership/Limited Liability Company (please print or type) By: ___________________________________________ (Signature of a Authorized General Partner/Manager/Member) ________________________________________________ Name and Title of Signing General Partner/Manager/Member (please print or type) Taxpayer Identification No.: ___________________________ E-mail Address: ____________________________________ Principal Business Offices: ____________________________________ ____________________________________ ____________________________________ ____________________________________ Mailing Address ____________________________________ (if different): ____________________________________ ____________________________________ ____________________________________ Attention: ____________________________ Executed at _____________________, ____________________ City State this _______ day of June___________, 20152016. EXHIBIT A PURCHASER QUESTIONNAIRE INSTRUCTIONS TO PURCHASER QUESTIONNAIRE BOSTON OMAHA CORPORATION This questionnaire must be completed by all investors. In order to subscribe as an investor for this offering, you must complete this questionnaire. If you have any questions concerning any of the information called for, or questions concerning whether you qualify as an accredited investor, you may ask your lawyer, accountant or representatives of the Company for assistance. If this Questionnaire is being completed for married individuals subscribing as joint tenants or tenants-in-common, it must be completed by the person making the investment decision on behalf of the joint tenants or tenants-in-common. If joint tenants or tenants-in-common are not married or are each making the investment decision if married, a separate questionnaire must be completed for each joint tenant or tenant-in-common.. PURCHASER QUESTIONNAIRE This Purchaser Questionnaire (this "Questionnaire") must be completed and delivered to BOSTON OMAHA CORPORATION, a Delaware corporation (formerly REO Plus, Inc.) (the "Company"), by you as a prospective purchaser of shares of Common Stock of the Company ("Common Shares"). The purpose of this Questionnaire is to determine whether you meet the standards imposed by Section 4(2) of, or Regulation D under, the Securities Act of 1933, as amended (the "Securities Act"). Eligibility is determined, among other things, by the ability of the investor to evaluate the merits and risks of an investment in Common Shares based on his or her knowledge and experience in financial and business matters, or by certain financial criteria. The undersigned understands that the offering of the Common Shares by the Company has not been, and will not be, registered under the Securities Act, the securities of "blue sky" laws of any state or other jurisdiction, and the Common Shares involved in this offering are being sold in reliance upon an exemption from the registration requirements thereof. Please thoroughly complete, sign and date this Questionnaire, and deliver it to: Gxxxxxx Axxxxxx, LLP 300 Xxxxx Xxxxxx, Xxxxx 000 Xxxxxxx, XX 00000 Attention: Jxxxxx X. Xxxxxxx jxxxxxxx@xxxxxxxxxxxxx.xxx Please contact Jxxxxx X. Xxxxxxx, counsel to the Company, at (000) 000-0000 if you have any questions with respect to this Questionnaire. Incomplete answers to questions or questions answered in such a way (either singly or collectively) so as to indicate to the Company that it should ask for more information will delay the Company's review of the Questionnaire and consideration of the proposed investment by the prospective investor. Your answers will be relied upon by the Company. Your answers will be kept confidential, except to the extent disclosure may be required under or in connection with any federal or state laws or if the contents are relevant to an issue in any action, suit or proceeding to which the Company is a party or by which it is or may be bound. However, each person who agrees to invest in the Company hereby agrees that the Company may present this completed Questionnaire or a copy of this completed Questionnaire to its attorneys or such other parties as it/they, in its/their sole discretion, deem appropriate to ensure that the proposed offer and sale of the Common Shares involved in this offering will not result in a violation of the registration provisions of the Securities Act or a violation of the securities or "blue sky" laws of any state or other jurisdiction. A false statement by you will constitute a violation of your representations and warranties under the Subscription Agreement and may also constitute a violation of law, for which a claim for damages may be made against you. This Questionnaire does not constitute an offer of Common Shares by the Company, but is merely a request for information. Please print or type:

Form of Ownership. Please indicate the form of ownership you desire. ________ Individual or entity or trust (one signature required, unless otherwise required by organization documents) ________ Joint Tenants with right of survivorship (both parties must sign) ________ Tenants-in-Common (all parties must sign) ________ Community Property (one signature required if Shares and Warrants held in one name, i.e., ranging spouse; two signatures required if Shares and Warrants are held in both names) ______________________________________________________________ Please PRINT here the exact name(s) in which you wish the Shares and Warrants registered. ______________________________________________________________ ACCEPTED: BOSTON OMAHA CORPORATION By: ________________________________ Name: Xxxx X. Xxxxx Title: President Dated: June July ___, 2015 SIGNATURE PAGE FOR PARTNERSHIP/LIMITED LIABILITY COMPANY INVESTORS Note: The partner(s), manager(s) or member(s) authorized to bind the partnership or limited liability company must sign and include a copy of the partnership, limited liability company or operating agreement, including any amendments. The agreement should include the date of formation of the partnership or limited liability company, a list of all partners or members (and managers, if any), the appropriate language authorizing this type of investment and the power of the general partner(s) or member(s) or manager(s) to sign on behalf of such entity. ______________________________________________________________ Name of Partnership/Limited Liability Company (please print or type) By: ______________________________________________________________ (Signature of a General Partner/Manager/Member) Taxpayer Identification No.: ___________________________ E-mail Address: Principal Business Offices: _______________________________________ ____________________________________ ____________________________________ ____________________________________ Mailing Address _______________________________________ (if different): _______________________________________ _______________________________________ _______________________________________ Attention: _______________________________________ Executed at _____________________, ____________________ City State this _______ day of JuneJuly, 2015. EXHIBIT A PURCHASER QUESTIONNAIRE INSTRUCTIONS TO PURCHASER QUESTIONNAIRE BOSTON OMAHA CORPORATION This questionnaire must be completed by all investors. In order to subscribe as an investor for this offering, you must complete this questionnaire. If you have any questions concerning any of the information called for, or questions concerning whether you qualify as an accredited investor, you may ask your lawyer, accountant or representatives of the Company for assistance. If this Questionnaire is being completed for married individuals subscribing as joint tenants or tenants-in-common, it must be completed by the person making the investment decision on behalf of the joint tenants or tenants-in-common. If joint tenants or tenants-in-common are not married or are each making the investment decision if married, a separate questionnaire must be completed for each joint tenant or tenant-in-common.

Form of Ownership. Please indicate the form of ownership you desirewhich the Subscriber desires for the Shares: ___ Individual ___ Joint Tenants with Right of Survivorship ___ Tenants in Common ___ Community Property _X_ Trust ___ Corporation ___ Partnership ___ Other: [Signature Page For Individual] DATED this ___ day of _________________, 2007. __________________________________ Individual or entity or trust (one signature required, unless otherwise required by organization documentsSignature) __________________________________ Joint Tenants with right of survivorship (both parties must signName - Please Print) __________________________________ Tenants-in-Common (all parties must signPrimary Place of Residence) __________________________________ Community Property (one signature required City, State and ZIP Code) __________________________________ (Telephone Number - Residence) __________________________________ (Telephone Number - Business) __________________________________ ACCEPTED this ____ day of _____________, 2007. QUEST GROUP INTERNATIONAL, INC. By___________________________________ [Signature Page For Corporation or Other Entity] DATED this 22nd day of May, 2007. Baradaran Revocable Trust (Name of Entity) /s/ Xxxxxxx Xxxxxxxxx (Signature of Authorized Person) Xxxxxxx Xxxxxxxxx, Trustee (Name and Title - Please Print) __________________________________ (Business Address) __________________________________ (City, State and ZIP Code) __________________________________ (Telephone Number - Business) ACCEPTED this 30th day of May, 2007. QUEST GROUP INTERNATIONAL, INC. By /s/ PURCHASER QUESTIONNAIRE (Individual) The purpose of this Questionnaire is to assure that each investor will meet the standards imposed by certain exemptions from registration under the Securities Act of 1933, as amended, and all applicable state laws. If the response to any item is "none" or "not applicable", please so indicate. Where multiple choices are offered, select and check only the most applicable and correct one. YOUR RESPONSES WILL BE KEPT STRICTLY CONFIDENTIAL. However, by signing this document, you agree that Quest Group International, Inc. (the "Company") may present the Questionnaire to such private and/or governmental entities as it deems appropriate, if Shares called upon to do so, in order to establish the availability under applicable state and Warrants held in one name, i.e., ranging spouse; two signatures required if Shares and Warrants are held in both namesfederal law of an exemption from registration. PLEASE PRINT Name(s) ______________________________________________________________ Please PRINT here 1. I am [ ] am not [ ] being advised on the exact name(s) in which you wish the Shares and Warrants registered. ACCEPTED: BOSTON OMAHA CORPORATION By: ________________________________ Name: Xxxx X. Xxxxx Title: President Dated: June ___, 2015 SIGNATURE PAGE FOR PARTNERSHIP/LIMITED LIABILITY COMPANY INVESTORS Note: The partner(smerits of this offering by a Purchaser Representative (investment advisor), manager(s) or member(s) authorized to bind the partnership or limited liability company must sign and include a copy of the partnership, limited liability company or operating agreement, including any amendments. The agreement should include the date of formation of the partnership or limited liability company, a list of all partners or members (and managers, if any), the appropriate language authorizing this type of investment and the power of the general partner(s) or member(s) or manager(s) to sign on behalf of such entity. __________________________________________ Name of Partnership/Limited Liability Company (please print or type) By: _______________________________________ (Signature of a General Partner/Manager/Member) Taxpayer Identification No.: ___________________________ E-mail Address: Principal Business Offices: ____________________________________ ____________________________________ ____________________________________ ____________________________________ Mailing Address ____________________________________ (if different): ____________________________________ ____________________________________ ____________________________________ Attention: ____________________________ Executed at _____________________, ____________________ City State this _______ day of June, 2015. EXHIBIT A PURCHASER QUESTIONNAIRE INSTRUCTIONS TO PURCHASER QUESTIONNAIRE BOSTON OMAHA CORPORATION This questionnaire must be completed by all investors. In order to subscribe as an investor for this offering, you must complete this questionnaire. If you have any questions concerning any of the information called for, or questions concerning whether you qualify as an accredited investor, you may ask your lawyer, accountant or representatives of the Company for assistance. If this Questionnaire is being completed for married individuals subscribing as joint tenants or tenants-in-common, it must be completed by the person making the investment decision on behalf of the joint tenants or tenants-in-common. If joint tenants or tenants-in-common are not married or are each making the investment decision if married, a separate questionnaire must be completed for each joint tenant or tenant-in-common.

Form of Ownership. Please indicate the form of ownership you desire. that the Subscriber desires for the Shares: ----- Individual ----- Joint Tenants with Right of Survivorship ----- Tenants in Common ----- Community Property ----- Trust ----- Corporation ----- Partnership ----- Other: [Signature Page For Individual] DATED this ___ day of _______, 2000. ---------------------------------- (Signature) ---------------------------------- (Name - Please Print) ---------------------------------- (Primary Place of Residence) ---------------------------------- (City, State and ZIP Code) ---------------------------------- (Telephone Number - Residence) ---------------------------------- (Telephone Number - Business) ---------------------------------- (Social Security or Taxpayer I.D. No.) ACCEPTED this ____ Individual or entity or trust (one signature required, unless otherwise required by organization documents) day of ________ Joint Tenants with right of survivorship (both parties must sign) ________ Tenants-in-Common (all parties must sign) ________ Community Property (one signature required if Shares and Warrants held in one name, i.e.2000. ONE WORLD XXXXXX.XXX , ranging spouse; two signatures required if Shares and Warrants are held in both names) ___________________________INC. By___________________________________ Please PRINT here the exact name(s) in which you wish the Shares and Warrants registered. ACCEPTED: BOSTON OMAHA CORPORATION By: [Signature Page For Corporation or Other Entity] DATED this ___ day of _______, 2000. ---------------------------------- (Name of Entity) ---------------------------------- (Signature of Authorized Person) ---------------------------------- (Name and Title - Please Print) ---------------------------------- (Business Address) ---------------------------------- (City, State and ZIP Code) ---------------------------------- (Telephone Number - Business) ---------------------------------- (Taxpayer I.D. No.) ACCEPTED this ____ day of _________________________ Name: Xxxx X. Xxxxx Title: President Dated: June ___, 2015 SIGNATURE PAGE FOR PARTNERSHIP/LIMITED LIABILITY COMPANY INVESTORS Note: The partner(s)2000. ONE WORLD XXXXXX.XXX, manager(s) or member(s) authorized to bind the partnership or limited liability company must sign and include a copy of the partnership, limited liability company or operating agreement, including any amendmentsINC. The agreement should include the date of formation of the partnership or limited liability company, a list of all partners or members (and managers, if any), the appropriate language authorizing this type of investment and the power of the general partner(s) or member(s) or manager(s) to sign on behalf of such entity. _______By___________________________________ Name EXHIBIT A PROMISSORY NOTE $200,000 May 22, 2000 FOR VALUE RECEIVED, the undersigned promises and agrees to pay to the order of Partnership/Limited Liability Company One World Xxxxxx.xxx, Inc. at 0000 Xxxxx 000 Xxxx, Xxxxx 000, Xxxxx, Xxxx 00000, or at such other place as the holder(s) hereof may designate in writing, the principal sum of TWO HUNDRED THOUSAND DOLLARS (please print $200,000.00), in lawful money of the United States of America, together with interest on the unpaid balance thereof at a rate of eight percent (8%) per annum until paid. Principal and all accrued interest shall be due in full on the third anniversary of this Note ("Due Date"). Any payments received before the Due Date shall first be applied toward the payment and satisfaction of accrued interest, and the remainder shall be applied toward the reduction of principal. Prepayment of principal may occur hereunder at any time without penalty. Notwithstanding the foregoing, in the event any sums provided to be paid hereunder, or typeunder any instrument given to secure the payment of the obligations evidence hereby, is not paid in full when due, the entirety of such payment shall, from the period beginning upon the date of said instrument(s) Byand continuing during the time it remains unpaid, both before and after judgment, bear interest at a rate of eighteen percent (18%) per annum. In the event: _______________________________________ (Signature a) petition is filed seeking that the undersigned be adjudged bankrupt; (b) the undersigned makes a general assignment for the benefit of creditors; (c) the undersigned suffers the appointment of a General Partner/Manager/Memberreceiver; (d) Taxpayer Identification No.: ___________________________ E-mail Address: Principal Business Offices: ____________________________________ ____________________________________ ____________________________________ ____________________________________ Mailing Address ____________________________________ the undersigned becomes insolvent; or (if different): ____________________________________ ____________________________________ ____________________________________ Attention: ____________________________ Executed e) the undersigned undergoes liquidation, termination, or dissolution, then in any, the entire remaining unpaid balance of both principal and interest owing hereunder shall, at _____________________the option of the holder hereof and without notice or demand, ____________________ City State this _______ day of June, 2015. EXHIBIT A PURCHASER QUESTIONNAIRE INSTRUCTIONS TO PURCHASER QUESTIONNAIRE BOSTON OMAHA CORPORATION This questionnaire must be completed by all investorsbecome immediately due and payable. In order any event, after acceleration of the maturity of the obligations evidenced hereby any unpaid principal balance and accrued interest shall, until paid and both before and after judgment, earn interest at a rate of eighteen percent (18%) per annum. The acceptance of any payment after the occurrence of a default or event giving rise to subscribe as an investor the right of acceleration provided for in this offeringparagraph shall not constitute a waiver of such right of acceleration with respect to such default or event or any subsequent default or event. In the event any payment under this Note is not made, you must complete this questionnaire. If you have or any questions concerning obligation provided to be satisfied or performed under any instrument given to secure the payment of the obligation evidenced hereby is not satisfied or performed, at the time and in the manner required, the undersigned agrees to pay any and all costs and expenses which may be incurred by the holder hereof in connection with the enforcement of any of its rights under this Note or under any such other instrument including court costs and reasonable attorneys' fees, whether incurred with or without suit or before or after judgment. Notwithstanding any other provision contained in this Note or in any instrument given to secure the information called forpayment of the obligation evidenced hereby: (a) the rates of interest, charges, and penalties provided for herein and therein shall in no event exceed the rates, charges and penalties which result in interest being charged at a rate equaling the maximum allowed by law; and (b) if, for any reasonable whatsoever, the holder hereof ever receives as interest in connection with the transaction of which this Note is part an amount which would result in interest being charged at a rate exceeding the maximum allowed by law, such amount or portion thereof as would otherwise be excessive unpaid principal balance then outstanding hereunder and not toward payment of interest. The makers, sureties, guarantors, and endorsers hereof severally waive presentment for payment, protest, demand, notice of protest, notice of dishonor, and notice of nonpayment, and expressly agree that this note, or questions concerning whether you qualify as an accredited investorany payment hereunder, you may ask your lawyer, accountant or representatives of the Company for assistance. If this Questionnaire is being completed for married individuals subscribing as joint tenants or tenants-in-common, it must be completed extended from time to time by the person making holder hereof without in any way affecting the investment decision on behalf liability of the joint tenants or tenants-in-common. If joint tenants or tenants-in-common are not married or are each making the investment decision if married, a separate questionnaire must be completed for each joint tenant or tenant-in-commonsuch parties.

Form of Ownership. Please indicate the form of ownership that you desiredesire for the Shares. ________ Individual or entity or trust (one signature required, unless otherwise required by organization documents) ________ Joint Tenants tenants with right of survivorship (both parties must sign) ________ Tenants-in-Common Tenants in common (all both parties must sign) ________ Community Property property (one signature required if Shares and Warrants interest held in one name, i.e., ranging managing spouse; two signatures required if Shares and Warrants are interest held in both names) _____ Trust (trustee must sign as follows: [name of trustee] as trustee for [name of trust] dated _______) _____ Corporation (signature of authorized party or parties) _____ Partnership (signature of general partner and additional signatures if required by the partnership agreement) _____ Limited Liability Company (signature of managing member and additional signatures if required by the limited liability company agreement) INDIVIDUAL SUBSCRIBERS ONLY _______________________ _______________________ Signature of Subscriber Signature of Joint Owner _______________________ _______________________ Printed Name of Subscriber Printed Name of Joint Owner _______________________ _______________________ Subscriber’s Social Joint Owner’s Social Security Number Security Number _______________________ _______________________ Residence Address Residence Address _______________________ _______________________ City State Zip City State Zip _______________________ _______________________ Telephone Number Telephone Number _______________________ _______________________ Email Address Email Address CORPORATIONS ONLY ____________________________________________________________________________________ Please PRINT here the exact name(s) in which you wish the Shares and Warrants registered. ACCEPTED: BOSTON OMAHA CORPORATION Name of Corporation (print or type)* By: ___________________________ (Signature of authorized agent) _____________________________ Title _____________________________ Taxpayer Identification Number * Please furnish corporate resolution. Corporation’s Address: _____________________________ _____________________________ _____________________________ _____________________________ Telephone Number __________________________________ Name: Xxxx X. Xxxxx Title: President Dated: June Email Address PARTNERSHIPS ONLY ___, 2015 SIGNATURE PAGE FOR PARTNERSHIP/LIMITED LIABILITY COMPANY INVESTORS Note: The partner(s), manager(s) or member(s) authorized to bind the partnership or limited liability company must sign and include a copy of the partnership, limited liability company or operating agreement, including any amendments. The agreement should include the date of formation of the partnership or limited liability company, a list of all partners or members (and managers, if any), the appropriate language authorizing this type of investment and the power of the general partner(s) or member(s) or manager(s) to sign on behalf of such entity. ______________________________________________________________________________________ Name of Partnership/Limited Liability Company Partnership (please print or type) )* By: _______________________________________ (Signature of a General Partner/Manager/Member) Taxpayer Identification No.general partner By: _____________________________ E-mail (Signature of additional general partner if required by partnership agreement) __________________________________ Taxpayer Identification Number * Please provide a copy of the executed partnership agreement. All partners should sign a subscription Agreement or indicate the authority of the partner who signs on behalf of the partnership. Partnership’s Address: Principal Business Offices: ____________________________________ ____________________________________ ____________________________________ __________________________________ Telephone Number ___ Mailing Address _____________________________________ (if different): Email Address TRUSTS OR RETIREMENT PLANS ONLY _______________________________________________________________________________________ Name of Trust or Retirement Plan (print or type) _______________________________________________________________________________________ Name of Trustee or Plan Fiduciary (print or type)* ________________________________ Date Formed By: ___________________________ Trustee’s or Plan Fiduciary’s signature ________________________________ Taxpayer Identification Number * Please provide a copy of the executed trust agreement if a trustee executes this page. If a plan fiduciary executes this page, please provide a statement executed by that fiduciary that this investment is in accordance with the terms of the plan and that the fiduciary is authorized to sign. Trustee/Fiduciary Address: ________________________________ ________________________________ ________________________________ ________________________________ Telephone Number ____________________________________ AttentionEmail Address ACCEPTANCE ACCEPTED as to _______ Shares. Date: ___________, 2006. STATE BANCORP, INC. By: ____________________________ Executed at _____________________, ____________________ City State this _______ day of June, 2015. EXHIBIT A PURCHASER QUESTIONNAIRE INSTRUCTIONS TO PURCHASER QUESTIONNAIRE BOSTON OMAHA CORPORATION This questionnaire must be completed by all investors. In order to subscribe as an investor for this offering, you must complete this questionnaire. If you have any questions concerning any of the information called for, or questions concerning whether you qualify as an accredited investor, you may ask your lawyer, accountant or representatives of the Company for assistance. If this Questionnaire is being completed for married individuals subscribing as joint tenants or tenants-in-common, it must be completed by the person making the investment decision on behalf of the joint tenants or tenants-in-common. If joint tenants or tenants-in-common are not married or are each making the investment decision if married, a separate questionnaire must be completed for each joint tenant or tenant-in-common.Its: