Form 133.34 - Undertaking Regarding Non-Issuer Sales
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1Form
133.34
Texas State Securities Board
P.O. Box 13167
Austin, Texas 78711-3167
Undertaking Regarding Non-issuer Sales
(§139.14)
Re: Sales of
_________________________________________________________
securities.
(Name of Issuer)
The undersigned, (Check one or more as applicable)
director
G
executive officer
G
owner of 15% or more of a class of voting securities or other ownership interests
G
of the issuer of the securities sought to be sold pursuant to §139.14, hereby affirms that none of
the proceeds from the sale(s) of such securities will inure to the benefit of the issuer.
Date:
By:
(Full Name - Printed or Typed)
(Signed Name)
Subscribed and sworn to before me this
______
day of
________________________
, 20_
____
.
Notary Public in and for the County of
State of
(NOTARY SEAL)
My commission expires
08-16-2010
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