COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOINTRASTATE 4 NY #STATUS REPORT OF INTRASTATE FINANCING (Name of Issuer) (Street Address) (City and State) (Zip) TO: ATTORNEY GENERAL OF THE STATE OF NEW YORK REAL ESTATE FINANCING BUREAU 120 BROADWAY -23RD FLOOR NEW YORK, N.Y. 10271 1. Period covered by this report:2. Date that offering commenced:GREETINGS:3. Date of last prior report:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County of4. Date offering completed (if completed):o'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in room5. Has the offering been discontinued: Yes No If Yes, please indicate whenYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.6. If offering has not commenced, state reasons briefly:, one of the Justices of theCourt in Witness, Honorableday of, 20 County,7. a) Total number and dollar amount of shares or other units offered:(Attorney must sign above and type name below)Attorney(s) forb) Number and dollar amount sold during the period covered by this report: c) Number and dollar amount sold during the period covered by prior reports: d) Number and dollar amount of shares or other units still being offered: e) Total amount received from public from commencement of offering to date: 8. Name and addresses of all banks where the issuer maintains accounts: 9. Name and address of each bank where funds from offering have been deposited, title of account and opening balance preceding this period:(a) $ (b) $ Balance in said accounts as of end of reporting period:Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)$(a) $(b) 10. Proceeds not heretofore accounted for were spent as follows:11. Have any of the securities of the issuer been "warehoused" or otherwise sold to persons who were acquiring same with a view towards resale? [ ] Yes [ ] No If Yes, please provide details on separate sheet.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12. Have there been any changes in the management of the issuer? [ ] Yes [ ] No If Yes, please provide details on separate sheet. 13. Have adequate books and records been set up? [ ] Yes [ ] No [ ] Not Yet Date such books were set up:THE PEOPLE OF THE STATE OF NEW YORK TOGREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,Name and address of independent public accountant:located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomIf not set up, explain reasons:Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply., one of the Justices of theCourt in Witness, Honorableday of, 20 County,14. Was this offering made on a Short Form Prospectus (INTRASTATE 5) [ ] Yes [ ] No If Yes, attach a copy or a photocopy of the subscription sheet of form INTRASTATE 5 as executed by each subscriber during the period covered by this report. (Issuer) By:Signature:Printed Name and Title: Telephone Number :(Attorney must sign above and type name below)Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com
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