Complaint Form - Commonwealth Of Pennsylvania Pennsylvania Securities Commission (Page 4 of 4) in pdf

Complaint Form - Commonwealth Of Pennsylvania Pennsylvania Securities Commission Page 4

2. Have you brought this complaint to the attention of others? Please check box(es) as appropriate.

U.S. Securities and Exchange Commission

Consumer protection agency- If so, which one?

Financial Industry Regulatory Authority

______________________________

Philadelphia Stock Exchange

District Attorney – If so, which one?

American Stock Exchange

______________________________

New York Stock Exchange

Your attorney – identify:

Commodity Futures Trade Commission

______________________________

NASDAQ

Other – identify: _____________________

If necessary, are you willing to appear as a witness, be sworn, testify and be cross-examined concerning the

allegations made in this complaint?

Yes

If no, why not?

_____________________________________________________________________________________

I have read this complaint, I fully understand its contents, and I certify that it and photocopies of attached documents are true

and correct to the best of my knowledge and belief.

______________________________________

________________________

Signature

Date

Return completed form and photocopied documents to:

PENNSYLVANIA SECURITIES COMMISSION

1010 N. SEVENTH STREET, 2ND FLOOR

EASTGATE OFFICE BUILDING

HARRISBURG, PA 17102-1410

Attn: Office of Secretary

Visit the Pennsylvania Securities Commission=s web site at

for investor information, news releases,

enforcement actions, and much, much more!

Complaint Form - Commonwealth Of Pennsylvania Pennsylvania Securities Commission Page 4