Form Es - Notice Of Proposed Release Of Funds From Escrow


Colorado Division of Securities
1560 Broadway Street, Suite 900
Denver, CO 80202
File No. _________________________
Pursuant to the requirements of section 11-51-302(6), C.R.S., this notice of proposed release of
funds from escrow and the following information is submitted:
1. Name of Offering:
2. Name of Issuer:
Address of Issuer:
4. Was the offering registered under Statute section 11-51-303, C.R.S., in Colorado?
______YES ______NO
If so, list the date the registration statement became effective. _____/_____/_____.
5. Was the offering registered under Statute section 11-51-304, C.R.S., in Colorado?
_____YES_____NO. If so, list the registration statement number assigned by the Colorado
Division of Securities:
6. List the gross amount of proceeds received from the sale of any and all of the securities
registered in Colorado:
7. Has the offering closed? ________YES________NO. Will any additional funds be received
by the issuer in exchange for securities issued in this offering? ________YES________NO.
If yes, state the amount of additional funds:
8. Has a transaction or series of transactions committing at least fifty percent (50%) of the gross
proceeds for use in one or more specific lines of business been completed? _____YES
_____NO. Describe the transaction or series of transactions, including the date of each
transaction, the parties to each transaction, the amount committed, a description of how the
proceeds are to be spent under the terms of each transaction, and the specific lines of business.
(use a separate page if necessary):
FORM ES (Rev. 7-2006)


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