Information Regarding The Filing Of Reports Of Sale Under Section 4.p Of The Illinois Securities Law Of 1953 - Illinois Secretary Of State Securities Department
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1
2Illinois Secretary of State
Information Regarding the Filing
Securities Department
of Reports of Sale Under Section
Jefferson Terrace, Ste. 300 A
4.P of the Illinois Securities Law
300 W. Jefferson St.
Springfield, IL 62702
of 1953
217-782-2256
1.
Type of Report being filed:
❏ Original
❏ Combination Final
❏ 6-Month Update
❏ Final
2.
The issuer, controlling person or dealer must file one copy of this report with the Securities Department’s Springfield office:
a .
no later than six months after the first sale of securities is made to an Illinois resident pursuant to Section 4.P of the Act (Original Report);
b .
every six months after the first sale of securities is made to an Illinois resident pursuant to Section 4.P of the Act until the Final Report
of Sale referred to in Item c below has been filed (6-Month Update); and
c.
no later than 30 days after the date on which the issuer, controlling person or dealer determines that no further sales of securities will
be made to Illinois residents pursuant to Section 4.P of the Act (Final Report).
Notwithstanding the foregoing, if the sales have been concluded within any 6-month period described in Item a or b above and a Report
on Form 4P is filed no later than the end of that period, but within the 30-day period described in item c above, then only one Report need
be filed (Combination Final).
Securities Department File Number:
3.
Issuer Information:
Name
Street Address
Telephone Number
City, State, ZIP
4 .
Controlling Person (Complete only if sales covered by this Report are for the direct or indirect benefit of such controlling person.):
Name
Street Address
Telephone Number
City, State, ZIP
5 .
Dealer (complete only if the Dealer is filing this Report):
Name
Street Address
Telephone Number
City, State, ZIP
6 .
Securities covered by this Report:
❏ Common Stock
❏ Preferred Stock
❏ N o t e s
❏ Bonds or Debentures
❏ Other Securities not listed above (describe):
Printed by authority of the State of Illinois. October 2005 — 100 — SEC 334
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