Psc/form Ro - Request For Waiver Of Procedures
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5PSC/Form RO
TDD Users: AT&T Relay Center: 1-800-654-5984
EFFECTIVE: 7/7/90
REVISED:
1/1/00
COM M ONW EALTH OF PENNSYLVANIA
PENNSYLVANIA SECURITIES COMM ISSION
Eastgate Office Building, 2nd Floor, 1010 N. 7th Street
Harrisburg, PA 17102-1410
(717) 787-8061
(1-800-600-0007 in PA)
Request for W aiver of Procedures under Regulation 504.060(b)
"RESCISSION OFFERS"
GENERAL INSTRUCTIONS
1.
One completed manually signed Form and all attachments should be filed with the Commission.
If mailed, it is advisable to send it by registered or certified mail, postage prepaid, return receipt
requested.
2.
Typewrite or print all answers in the space provided. If the space is insufficient, attach a schedule
to the Form and make reference in the Form to each item included.
3.
Do not abbreviate names or use initials. All questions should be answered fully.
4.
In answering any question in the Form, the Offeror may incorporate by reference information
contained in any document attached thereto or previously on file with the Commission. Any such
reference should be to the page and paragraph number or other specified portion of the document
where the information is located.
5.
The Form filed with the Commission must be manually signed by the Offeror. If the Offeror is a
corporation, it should be signed in the name of the corporation by an executive officer duly
authorized; if a partnership, it should be signed in the name of the partnership by a general partner;
and if an unincorporated association or other organization not a partnership, it should be signed
in the name of such organization by a person responsible for the direction or m anagem ent of its
affairs. W ith respect to Item 8, the chief executive officer, chief operating officer or chief financial
officer must sign on behalf of the corporate general partner, if applicable.
6.
No filing fee is required with this Form .
7.
Please remove this instruction sheet before filing this Form .
DISCLOSURE GUIDE
8.
Attach a copy of disclosure prepared to satisfy the anti-fraud provisions of Section 401(b) of the Act
which will be given to each rescission offeree, including the specific source of payment for the
rescission offer.
9.
W here the Offeror is the issuer and plans to continue offering its securities for sale in Pennsylvania,
detailed disclosure should be given if the proceeds from the sale of additional securities will be
used to effect the rescission offer.
10.
Attach a copy of the proposed Notice of Rescission Offer which contains only the information set
forth in Item 14. You are strongly advised to refrain from distributing the rescission offer m aterials
until the completion of the staff review period set forth in Regulation 504.060(b)(1), in the event
the W aiver Request is denied.
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