Issuer Report Of Sales In Limited Offerings Form. This is a South Dakota form and can be use in Blue Sky Secretary Of State.
Tags: Issuer Report Of Sales In Limited Offerings, IRS, South Dakota Secretary Of State, Blue Sky
SD EForm - 0289 V1 State of South Dakota Office of The Division of Securities Issuer Report of Sales In Limited Offerings (SDCL 47-31B-203) A report of sales on this form, relating to a limited offering of securities exempted from registration under SDCL 47-31B-203, must be submitted by the issuer of the securities (even though sales were not made in South Dakota) within 30 days after the offering is terminated. Under SDCL 47-31B-203, the exemption for any offer or sale of securities may be withdrawn with respect to any offer or sale by or on behalf of any issuer or other person who has failed to file the most current required report of sales. 1. Name of Issuer 2. Address of Issuer 3. Description of securities sold 4. Name and title or position of each person who solicited the sales which are the subject of this report (Use separate sheet if necessary.) 5. In the space provided on the next page, report for each South Dakota purchase of the Issuer's securities (for which this report is required) the name and address of the purchaser, the number of shares or units purchased by each such person, the purchase price (per unit and total), and the date of such purchase. 6. To the knowledge of the Issuer, is any purchaser named in item 5 above a joint or common owner, or beneficial owner of the securities; or a corporation, partnership, or other entity, organized in connection with offer or sale of the Issuer's Securities? Y .N If so, explain on separate sheet. 7. Did anyone receive a commission or other remuneration for selling or soliciting the purchase of these securities in South Dakota? Y . If so, explain o separate sheet. N 8. Was any circular, prospectus, advertisement or other material published or circulated (in South Dakota) in connection with the offer and sale of these securities? Y . N If so, enclose a copy of any such written or printed material which has not been previously submitted. American LegalNet, Inc. www.FormsWorkFlow.com Name and Address of Purchaser Check Investor Status Acc Non Acc Number of Shares Or Units Purchased Name Of Selling Agent Price Per Share or Unit Total Price Date of Purchase 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 (continue on additional sheet, if necessary) The issuer certifies that the foregoing is a complete and accurate report of sales of its securities in South Dakota as of Date , 20 , 20 , , for termination and final report By Name (Print o Type) (Issuer) Signature If sending electronically, please fill in this field. If sending via mail, please hand sign. Title American LegalNet, Inc. www.FormsWorkFlow.com