OHNS: Quality Designation Examination Form

                                 FIRST EXAMINER

IN MY OPINION, the coin shown in the enclosed photograph is:

Subject: _______________________________________________________________________

Quality Designation                Explanation

___Superior      _______________________________________________________________

___Above Average _______________________________________________________________

___Average       _______________________________________________________________

___Below Average _______________________________________________________________

___Crude         _______________________________________________________________

Coin:  __________________  Probable Artist:  ___________________________________

Observations:  _________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Signed:  ____________________________  Date:  __________________________________

                                 SECOND EXAMINER

IN MY OPINION, the coin shown in the enclosed photograph is:

Subject: _______________________________________________________________________

Quality Designation                Explanation

___Superior      _______________________________________________________________

___Above Average _______________________________________________________________

___Average       _______________________________________________________________

___Below Average _______________________________________________________________

___Crude         _______________________________________________________________

Coin:  __________________  Probable Artist:  ___________________________________

Observations:  _________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Signed:  ____________________________  Date:  __________________________________

                                                                 8 November 2008