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Quarterly Status Report Of Registration And Use Of Proceeds SRQ-1 - Maryland

Quarterly Status Report Of Registration And Use Of Proceeds Form. This is a Maryland form and can be used in Securities Blue Sky Secretary Of State .
 Fillable pdf Last Modified 9/28/2005
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FORM SRQ-1 QUARTERLY STATUS REPORT OF REGISTRATION AND USE OF PROCEEDS 1. Name of issuer: Address: Maryland file no.: Original effective date in Maryland: 2. Description of securities: 3. Period covered by current report: thru 4. Name of all broker-dealers and individual issuer agents offering in Maryland the securities described in #2: 5. OFFERING STATISTICS Minimum Maximum Price Offering Amount $ Offering Amount $ Per Share $ PROCEEDS TO UNDERWRITING SHARES THE COMPANY DISCOUNT/COMMISSIONS Total amount offered in Maryland . . . . . . . . . . . . . $ $ Aggregate subscriptions received or amount sold to date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ $ Aggregate subscriptions received or amount sold since last report . . . . . . . . . . . . . . . . . . . . . . . . . . . $ $ Unsold amount of remaining offering . . . . . . . . . . $ $ Amount remaining to break escrow, or . . . . . . . . . $ $ Date escrow was satisfied: <<<<<<<<<********>>>>>>>>>>>>> 2 Form SRQ-1/Page 2 6. State briefly the nature and extent of each of the issuers principal activities since the effective date in Maryla nd: 7a. USE OF PROCEEDS Set forth the manner in which the net proceeds have been used (approximations): DESCRIPTION OF USE AMOUNT REPORTED AMOUNT USED SINCE AGGREGATE ON LAST REPORT LAST REPORT AMOUNT USED 7b. DESCRIPTION OF ANY CHANGES IN USE OF PROCEEDS If there is any deviation between the stated use of proceeds in the offering disclosure and the actual use, please describe specifically the amount and the reasons for the deviation: 8. Please attach a list of subscribers, including the name, address and amount of subscription of each subscriber. I, , hereby affirm, under the penalties of perjury, (name and title) that the information provided on this form is complete, true and accurate. Signature of Executive Officer: Printed Name: Title of Executive Officer: Date Signed: 1/99
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