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Form 6(A)(4) - Registration By A Corporation Of A Proposed Sale Of Additional Securities To Existing Security Holders Pursuant

STATE OF OHIO

Department of Commerce

Telephone:

File No.

(614) 644-7381

Division of Securities

77 South High Street, Columbus, Ohio 43215-6131

Form 6(A)(4)

Registration by a Corporation of a Proposed Sale of Additional Securities to

Existing Security Holders Pursuant to R.C. Section 1707.06(A)(4).

Registrant Must Not Complete.

Checked

Date

Division Record --

Notation

Fee ($50.00) Received

Prior registrations checked

Examined as to form

Amendment requested

Accepted for filing

Acknowledgment sent

Registration withdrawn

Registration suspended

Registration refused

Examination requested

This Registration (Registrant Must Not Complete.)

(Price)

(File)

(Date)

(Description)

(Section)

(Amount)

Note: Use this form if sub-items (a), (b) and (c) of item 11 can be answered in the affirmative. Check each of these sub-items before

starting to complete this form.

If the space provided on this form is inadequate for full response, attach an exhibit numbered to correspond to the number of the question

thereby answered.

Integration: The issuer should be aware that all sales of securities before or after this filing may be subject to integration with this offering by

the Division. Factors considered particularly relevant to integration include: 1) Are the offerings part of a single plan of financing? 2) Do the

offerings involve issuance of the same class of security? 3) Are the offerings made at or about the same time? 4) Is the same type of consider-

ation to be received? 5) Are the offerings made for the same general purpose?

COMPLETE ALL ITEMS

Issuer's corporate name

(Payer's Federal Tax Identification Number)

Issuer's principal business office

(Street and Number)

(Phone)

(City, State, Zip)

Statutory Agent:

(Name)

(Street and Number)

(Phone)

(City, State, Zip)

Date and state of issuer's incorporation:

(Month, Day and Year)

(City, State, Zip)

(State)

State specifically the actual business in which issuer is engaged or will engage:

COM 4593 (Rev. 9/05)

Form 6(A)(4) - Registration By A Corporation Of A Proposed Sale Of Additional Securities To Existing Security Holders Pursuant

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