Form 041 - Filing Of Information Pertaining To A Control Bid

STATE OF OHIO

Department of Commerce

Telephone:

Division of Securities

(614) 644-7381

File No. ______________

77 South High Street, 22nd Floor, Columbus, Ohio 43215

FORM 041

FILING OF INFORMATION PERTAINING TO A CONTROL BID

Pursuant to Section 1707.041 of the Revised Code of Ohio

Division Record

Date

Checked By

Notation

Do Not Fill In

Received by Division

Record Made

Other Filings under this Section by this Offeror:

File No.

INSTRUCTIONS: Responses may be made either directly on this form, by reference to documents and exhibits filed with this form, or a

combination of both. If the space provided on this form is inadequate for full response, or if response will be made by referring to a

document or exhibit filed with this form, attach an exhibit numbered to correspond to the number of the item being answered, and note the

reference to the exhibit in the space provided. If the exhibit consists of more than one page, indicate the relevant page number(s). If there

is more than one Offeror, each Offeror should fill out Part Two of this form. Please DO NOT LEAVE ANY ITEM BLANK. If an item will

not be answered, note either that the item is not applicable (NA), or, if reasonable investigation of information actually or publicly available

to the Offeror has not revealed the answer, that the answer is unknown (UK).

PART ONE: SUBJECT COMPANY

EXHIBIT

REFERENCES

1707.01(Y)(1)

State the name and principal place of business of the Subject Company,

including the street address, telephone number and facsimile number.

State the name, address, telephone number and facsimile number of the

Subject Company's legal counsel:

State the location of the principal executive office of the Subject Com-

1707.01(Y)(1)

pany, including the address, telephone number and facsimile number:

State the form of organization of the Subject Company, the date on which

it was formed, and jurisdiction in which it was organized:

1707.041(A)(2)(h)

1707.23(A)

Indicate if the Subject Company is any of the following:

A banking corporation subject to regulation by the Ohio Division of

Financial Institutions

1707.041(C)

1707.01(M)

YES

A savings and loan association subject to regulation by the Ohio Division

1707.01(O)

of Financial Institutions.

YES

A public utility corporation subject to regulation by the Ohio Public Utili-

ties Commission

YES

COM 4522 (1-99)

Form 041 - Filing Of Information Pertaining To A Control Bid - 1999

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