Form 10-2-1a - Closing Report: Registration By Qualification - 1990
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1(Rev.2/9/90)
STATE OF UTAH
DEPARTMENT OF COMMERCE
DIVISION OF SECURITIES
FORM 10-2-1A
Closing Report: Registration by Qualification
Date
Name of Issuer
File No.
Address
Street Number
City & State
Zip Code
1.
Total of issue offered in all states:
Total number of securities:
Total dollar amount of securities:
2.
Total sales made in all states:
Total number of securities:
Total dollar amount of securities:
3.
Total sales made in Utah:
Total number of securities:
Total dollar amount of securities:
4.
Gross amount of proceeds received from all sales:
5.
Amount of commissions paid:
6.
Amount of other offering expenses:
7.
Net Proceeds:
By
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