Notice Of Transaction Pursuant To Rule 830-X-6-.12 Form - Alabama Securities Commission

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Alabama Securities Commission File No., if any
______________________________________
(Insert File number(s) of Previous Filings before
the Securities Commission, if any).
FEE: $300.00
See Alabama Code section 8-6-11(a)(9)
ALABAMA SECURITIES COMMISSION
STATE OF ALABAMA
NOTICE OF TRANSACTION PURSUANT TO
RULE 830-x-6-.12
1.
Name of Issuer:
________________________________________________________________________
2.
Address of Issuer:
________________________________________________________________________
Street
City
State
Zip Code
Mailing Address (if different than above):
________________________________________________________________________
Street
City
State
Zip Code
3.
Area Code and Telephone Number ___________________________________________
Issuer’s State (or other jurisdiction) of incorporation or organization:
4.
_______________________________________________________________________
5.
Title of class or classes of securities sold in transaction:
_______________________________________________________________________
_______________________________________________________________________
6.
Enter the information request for the following:
Each promoter of the issuer, if the issuer has been organized within the past five
years;
Each beneficial owner having the power to vote or dispose, or direct the vote or
disposition of, 10% or more of a class of equity securities of the issuer;
Each executive officer and director of corporate issuers and of corporation general
and managing partners of partnership issuers; and
Each general and managing partner of partnership issuers.

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