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Report Of Sales Of Securities And Use Of Proceeds Therefrom OFR-S-10-91 - Florida
| Report Of Sales Of Securities And Use Of Proceeds Therefrom Form. This is a Florida form and can be used in Securities Offerings-Registration Blue Sky Secretary Of State . |
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STATE OF FLORIDA OFFICE OF FINANCIAL REGULATION REPORT OF SALES OF SECURITIES AND USE OF PROCEEDS THEREFROM For Period From 1. Name of issuer: 2. Permit No.: 3. Name of Underwriter, if any: 4. (a) Date Offering commenced: (b) If offering has not commenced, state reasons briefly: 5. (a) Date offering completed, if completed: (b) If offering was terminated prior to completion, explain briefly: 6. (a) Total amount of securities registered. Give the title, number of shares, offering price and aggregate sales amount. (b) Amount of securities sold from commencement of offering to date: (c) Amount of securities still being offered: 7. Total amount received from public from commencement of offering to date: $ 8. We report herewith sales of Date Last Registered in Florida for the Amount Last Registered in Florida ______ period ended Amount Sold for = Period . to . - Unsold Balance If offering has been completed, show amount sold in Florida: 9. Furnish a reasonably itemized statement of the use made of the proceeds from the sale of the securities from the commencement of the offering to date. Instructions: 1. State separately: (a) underwriting discounts and commissions; (b) expenses paid to or for the underwriters; (c) other expenses of the offering paid to date by or for the account of the issuer; and (d) each other purpose for which a substantial amount of the proceeds has been used. 2. As to each category of expenditures, state separately: (a) payments to directors, officers and affiliates; and (b) payments to other persons. 3. If any of the proceeds were used for any purpose not indicated in the prospectus, so state and give the reason for deviating from the use of proceeds as set forth in the prospectus. If all of the proceeds were used for the purpose indicated in the prospectus, so state. (Issuer) Date: By: ____________________________________________________ OFR-S-10-91, Report of Sales of Securities and Use of Proceeds Therefrom, Effective 11/22/10, Incorporated by Reference in Rule 69W-301.002, F.A.C. 1 American LegalNet, Inc. www.FormsWorkFlow.com Signature and Title Instructions as to signature. The report shall be signed on behalf of the issuer by an officer of the issuer or by some other duly authorized person. OFR-S-10-91, Report of Sales of Securities and Use of Proceeds Therefrom Effective ________________, Incorporated by Reference in Rule 69W-301.002, F.A.C. American LegalNet, Inc. 2 www.FormsWorkFlow.com
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