Form 500-12 - Notice Of Withdrawal Of Registration
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1NEVADA FORM 500-12
NOTICE OF WITHDRAWAL OF REGISTRATION
TO:
SECRETARY OF STATE
DATE:
SECURITIES DIVISION
555 E. WASHINGTON AVE., SUITE 5200
LAS VEGAS, NV 89101
1.
The undersigned hereby gives NOTICE OF WITHDRAWAL of the following
application for registration in the State of Nevada:
Issuer:
Address:
(Street)
(State)
(City)
(Zip Code)
-
Nevada Securities Division File Number:
I certify that no sales of securities in connection with this application for registration have
2.
occurred in the State of Nevada except:
None
Sales identified on the Attached Sheet.
Note: If any sales have occurred, the issuer must submit a complete accounting
of all sales satisfactory to the Securities Division and await formal written
approval of withdrawal by the Division.
I understand that no refund of any filing fee in connection with this application will be
3.
made.
SUBMITTED BY:
TEL:
(
)
Address:
(Street)
(City)
(State)
(Zip Code)
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