Form Se-1 - Statement Of Claim For The Exemption Of Securities Of A New Generation Processing Entity

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Robin Carnahan
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Secretary of State
State of Missouri
Securities Division • 600 W. Main • PO Box 1276
Jefferson City, MO 65102
Statement of Claim for the Exemption of Securities
of a New Generation Processing Entity
1. Name and principal address of the issuer: ______________________________________________________________________
________________________________________________________________________________________________________
2. Date of organization of the issuer and the form of organization, including the Missouri statute under which the issuer was created:
________________________________________________________________________________________________________
3. Name, address and telephone number of the correspondent to whom notices and communications regarding the notice filing may
be sent:
________________________________________________________________________________________________________
4. Provide a statement that explains how the issuer and its business meets the definition of a “new generation processing entity” under
Missouri Regulation 15 CSR 30-54.190(1).
________________________________________________________________________________________________________
________________________________________________________________________________________________________
5. Has the issuer previously sold securities in Missouri?
If yes, please describe and explain how these sales complied with the Missouri securities laws.
6. Please describe the offering as follows:
Total Offering
Offering in This State
Offering Price
or Proposed
No. of Shares
No. of Shares
Description of Securities
Offering Price
or Units
Amount
or Units
Amount
$
$
Totals
$
$
FORM SE-1 (01-05)

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