Notice Of Sale Of Securities Pursuant To Accredited Investor Exemption Form Page 3

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4. This Offering:
Description of
Price per
Number of Securities
Aggregate Dollar
Security
Security
to be Offered
Amount
Debt
Equity (common
or preferred)
Convertible
Security
Partnership
Interests
Other (Specify)
5. Description of Business:
6. Name of Broker-Dealer who has solicited or intends to solicit purchasers in this state:
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