Form 209 - Report On Sales Of Securities - Pennsylvania Securities Commission printable pdf download

Form 209

TDD/AT&T Relay Center: 1-800-654-5984

Instructions

EFFECTIVE: 10/11/97

REVISED: 12/23/04

PENNSYLVANIA SECURITIES COMMISSION

Eastgate Office Building, 2nd Floor, 1010 N. 7th Street

Harrisburg, PA 17102-1410

(717) 787-8061

(1-800-600-0007 in PA)

REPORT ON SALES OF SECURITIES

GENERAL INSTRUCTIONS

W HO M UST FILE:

Issuers which have sold securities in Pennsylvania pursuant to registration by

qualification under Section 206, EXCEPT where the offering is registered under Section 5 of the Securities

Act of 1933 AND the maximum fee has been paid (see Section 602(b)(iii)).

W HEN TO FILE: File Form 209 within 420 days after the effective date of the registration statement in

Pennsylvania.

For a further explanation of terms used in the Form, refer to Section 102 of the Pennsylvania Securities

Act of 1972 (“1972 Act”).

One manually signed copy of the Form with all attachments shall be filed with the Commission. If

mailed, it is advisable to send it by registered or certified mail, postage prepaid, return receipt

requested.

Typewrite or print all answers in the space provided. Answer each item completely. An answer of "not

applicable" is inappropriate. If the space is insufficient, attach a schedule to the Form and make

reference to each item included in the schedule.

The Form filed with the Commission must be manually signed by the issuer. If the issuer 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, this Form should be signed in the

name of such organization by a person responsible for the direction or management of its affairs.

In the event that, at any time after the filing of the Form, the issuer becomes aware that any information

provided on the Form becomes inaccurate in any material respect, the issuer shall file an amendment

with the Com mission within 5 business days from the date the issuer became aware that the

information previously submitted was inaccurate at the time it was filed.

In lieu of answering any specific question in the Form, the issuer 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.

7. Please remove instruction sheet before filing this Form .

Form 209 - Report On Sales Of Securities - Pennsylvania Securities Commission