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Notice Of Withdrawal Of Registration 500-12 - Nevada
| Notice Of Withdrawal Of Registration Form. This is a Nevada form and can be used in Securities Division Blue Sky Secretary Of State . |
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NEVADA FORM 500-12 NOTICE OF WITHDRAWAL OF REGISTRATION TO: DATE: SECRETARY OF STATE SECURITIES DIVISION 555 E. WASHINGTON AVE., SUITE 5200 LAS VEGAS, NV 89101 .1 The undersigned hereby gives NOTICE OF WITHDRAWAL of the following application for registration in the State of Nevada: Issuer: Address: (Street) (City) (State) (Zip Code) Nevada Securities Division File Number: 2. I certify that no sales of securities in connection with this application for registr ation have occurred in the State of Nevada except: None Sales identified on the Attached Sheet. Note: If any sales have occurred, the issuer must submit a complete acco unting of all sales satisfactory to the Securities Division and await formal written approval of withdrawal by the Division. 3. I understand that no refund of any filing fee in connection with this ap plication will be made. SUBMITTED BY: TEL: ( ____)________________ Address: (Street) (City) (State) (Zip Code) (Form approved by the Office of the Secretary of State. 12;92)
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