Form 8-Ne - Statement Demonstrating Eligibility For Registration By Notification printable pdf download

Form 8-Ne - Statement Demonstrating Eligibility For Registration By Notification

SECURITIES AND BUSINESS REGULATION

2 Martin Luther King, Jr. Drive, S.E.

Ste 802, West Tower

Atlanta, Georgia 30334

(404) 656-3920

ROBERT D. TERRY

KAREN HANDEL

Assistant Commissioner of Securities

Commissioner of Securities

STATEMENT DEMONSTRATING ELIGIBILITY FOR REGISTRATION BY NOTIFICATION

Georgia Securities Act of 1973, as amended

O.C.G.A. §10-5-5(d)

1. Name of issuer:

2. How long has the issuer been in continuous operation?

If less than 5 years, give name of

predecessors and state length of time each has been in continuous operation:

3. Has there been any default during the current fiscal year, or within the 3 preceding fiscal years, in the payment of principal,

interest or dividends on any security, of the issuer or any predecessor, with a fixed maturity or a fixed interest or dividend

provision?

4. Give the following information as to all securities without a fixed maturity or a fixed interest or dividend provision:

Class of Securities

No. of

Maximum Offering

Market Price

Book Value

Now Outstanding

Units

Price Per Unit*

Per Unit*

Per Unit**

Amount***

TOTAL

*The maximum offering price or the market price may be on a day selected by the applicant but must be

within 30 days before the date of filing this registration statement.

**Book value may be on a day selected by the applicant but must be within 90 days before the date of filing this

registration statement. Book value may be used only if there is neither a readily determinable market price nor a cash

offering price. (If book value is used, attach balance sheet from which the same is determined.)

***The amount extended is the product of either (1) the number of units times the higher of the maximum

offering price or the market price, or (2) the number of units times the book value.

Form 8-NE Rev. 1/2007

Form 8-Ne - Statement Demonstrating Eligibility For Registration By Notification