TABLE I –– SECURITIES TO BE SOLD
Furnish the following information with respect to the acquisition of the securities to be sold
and with respect to the payment of all or any part of the purchase price or other consideration therefor:
Name of Person from Whom Acquired
Nature of Acquisition Transaction
Nature of Payment
(If gift, also give date donor acquired)
If the securities were purchased and full payment therefor was not made in cash at
the time of purchase, explain in the table or in a note thereto the nature of the
consideration given. If the consideration consisted of any note or other obligation,
or if payment was made in installments describe the arrangement and state when
the note or other obligation was discharged in full or the last installment paid.
TABLE II –– SECURITIES SOLD DURING THE PAST 3 MONTHS
Furnish the following information as to all securities of the issuer sold during the past 3 months by the person for whose account the securities are to be sold.
Name and Address of Seller
Title of Securities Sold
Date of Sale
See the definition of “person” in paragraph (a) of Rule 144. Information is to be given not only as
The person for whose account the securities to which this notice relates are to be
to the person for whose account the securities are to be sold but also as to all other persons included
sold hereby represents by signing this notice that he does not know any material
in that definition. In addition, information shall be given as to sales by all personswhose sales are
adverse information in regard to the current and prospective operations of the
required by paragraph (e) of Rule 144 to be aggregated with sales for the account of the person filing
Issuer of the securities to be sold which has not been publicly disclosed.
DATE OF NOTICE
The notice shall be signed by the person for whose account the securities are to be sold. At least one copy of the notice shall be manually signed.
Any copies not manually signed shall bear typed or printed signatures.
Intentional misstatements or omission of facts constitute Federal Criminal Violations (See 18 U.S.C. 1001)
SEC 1147 (01-04)