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| SEC 816 (3-99) | Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
| OMB APPROVAL | |
| OMB Number: 3235-0286 | |
| Expires: October 31, 2001 | |
| Estimated average burden hours per response...12.00 |
For period ending ____/____/____
| Indicate whether the report is an | initial report | [ ] |
| amendment | [ ] | |
| or final report | [ ] |
If the report is an amendment, indicate the number of such amendment. [ ][ ]
If the offering has terminated, indicate the date of termination ____/____/____
The report shall be filed in accordance with the provisions of Rule 257 of Regulation A.
Answer each item in the box(es) or spaces provided. If additional space is required for any response, continue the response on an attached sheet.
If the issuer is required to file any report(s) on this form subsequent to its initial filing, each subsequent filing shall be deemed an amendment to the initial filing. Do not report in any amendment responses to Items 311 unless the information has changed.
No fee is required to accompany this filing.
Seven copies of the form shall be filed with the main office of the Commission in Washington, D.C. At least one copy of the form shall be manually signed; other copies may bear typed or printed signatures.
1. __________________________________________________________________________
2. Date of qualification of the offering statement: ________/________/_________
3. Has the offering commenced? [ ] Yes [ ] No.
If yes, date of commencement: _______/______/______
If no, explain briefly: _________________________________________________
4. Did the offering terminate before any securities were sold? [ ] Yes [ ] No.
If yes, explain briefly:
_____________________________________________________________________
If "yes", do not answer Items 5-11.
5. Did the offering terminate prior to the sale of all the securities
qualified under Regulation A?
[ ] Yes
[ ] No.
If yes, explain briefly:
___________________________________________________________________________
6. Indicate the total number of shares or other units offered and sold to date:
_________________ (issuer's account) ________________ (selling securityholders)
Indicate the number of shares or other units still being offered:
________________ (issuer's account) ________________ (selling securityholders)
7. Total amount of dollars received from the public to date. $ ______________
Total amount allocable to selling securityholders: $ _________________
| Underwriting discount or commission allowed | $ ______________ | |
| Underwriting expenses paid | $ ______________ | |
| Finders' Fees | $ ______________ | |
| Other expenses paid to date by or for issuer: | ||
| Legal (including organization) | $ ______________ | |
| Accounting | $ ______________ | |
| Engineering | $ ______________ | |
| Printing and Advertising | $ ______________ | |
| Other (specify) _____________________ | $ ______________ | |
| ____________________________ | $ ______________ | |
| ____________________________ | $ ______________ | |
| Total costs and expenses | $ ______________ | |
| Total net proceeds remaining. | $ ______________ |
8. Uses of net proceeds to date.
Instructions:
- Do not include any amount in "working capital" to which a more specific category is applicable.
- Round all amounts to the nearest dollar.
- Specify under "other purposes" any purpose for which at least 5% of the issuer's proceeds or $50,000, whichever is less, has been used.
| Salaries and fees | $ ______________ | |
| Construction of plant, building and facilities | $ ______________ | |
| Purchases and installation of machinery and equipment | $ ______________ | |
| Purchase of real estate | $ ______________ | |
| Acquisition of other business(es) | $ ______________ | |
| Repayment of indebtedness | $ ______________ | |
| Working capital | $ ______________ | |
| Development expense (product development, research, patent costs, etc.) | $ ______________ | |
| Temporary investment (specify) ________________________ | $ ______________ | |
| ___________________________ | $ ______________ | |
| ___________________________ | $ ______________ | |
| ___________________________ | $ ______________ | |
| Other purposes (specify)_____________ | $ ______________ | |
| ___________________________ | $ ______________ | |
| ___________________________ | $ ______________ | |
| ___________________________ | $ ______________ | |
| ___________________________ | $ ______________ | |
| ___________________________ | $ ______________ | |
| ___________________________ | $ ______________ | |
| ___________________________ | $ ______________ | |
| ___________________________ | $ ______________ | |
| ___________________________ | $ ______________ | |
| ___________________________ | $ ______________ |
9. Do the use(s) of proceeds in Item 8 represent a material change in the use(s) of proceeds described in the offering circular? [ ] Yes [ ] No.
If yes, explain briefly:
___________________________________________________________________________
10. State the number of shares held by each promoter, director, officer or controlling person of the issuer, if different from the amount stated in the offering circular.
___________________________________________________________________________
11. List the names and addresses of all brokers and dealers who have, to the knowledge of the issuer or underwriters, participated in the distribution of the securities during the period covered by this report.
___________________________________________________________________________
Pursuant to the requirements of Rule 257 and Regulation A, ________________________________ has caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
| __________________________________________________________________ Issuer | |
| ___________________ Date |
By
____________________________________________________________ Signature |
Instruction:
The report shall be signed by an executive officer, general partner or counsel of the issuer or by any other duly authorized person. The name and any title of the person who signs the report shall be typed or printed beneath the signature.
http://www.sec.gov/smbus/forms/2-a.htm
Last update: 06/23/1999
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