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Pennsylvania SOI Supplement SOIS - Pennsylvania

Pennsylvania SOI Supplement Form. This is a Pennsylvania form and can be used in Securities Blue Sky Department Of State .
 Fillable pdf Last Modified 10/5/2005
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NOTE TO USERS: The following form sets forth the minimum informational requirement for soliciting indications of interest under the Pennsylvania Securities Act of 1972 ( 1972) when used in conjunction with Form SOI. You may include additional information if you think it ne cessary or desirable. Remember that any discussion in this document is subject to the anti-fraud provis ions of the 1972 Act and must therefore be complete. You may not exaggerate the investment opportunity , minimize the risks of the enterprise or predict revenues, profits or payment of dividends (includ ing financial projections and forecasts). The information in the Pennsylvania SOI Supplement is an integral part o f the SOI Form and MUST accompany the SOI Form information at all times and under all c ircumstances. PENNSYLVANIA SOI SUPPLEMENT NAME OF COMPANY Check the appropriate response(s)) 1. The issuers revenues during the last full fiscal year were: a. Less than $10,000 . b. $10,000 or more but less than $50,000 . c. $50,000 or more but less than $250,000 . d. $250,000 or more but less than $1 million . e. $1 million or more . f. Issuer has been in existence for less than a full fiscal year . 2. The issuer had a profit or loss during its last full fiscal year of: a. PROFIT OF: Less than $10,000 . $10,000 or more but less than $50,000 . $50,000 or more but less than $250,000 . $250,000 or more . b. LOSS OF: Less than $10,000 . $10,000 or more but less than $50,000 . $50,000 or more but less than $250,000 . $250,000 or more . c. Issuer has been in existence for less than a full fiscal year . 3. The average price per share of stock paid in cash by the issuers curren t shareholders was: a. Less than $.01 . b. $.01 or more but less than $.05 . c. $.05 or more but less than $.10 . d. $.10 or more but less than $.25 . e. $.25 or more but less than $1.00 . f. $1.00 or more . 61 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 24. The issuer has engaged in the following transactions with its officers, directors, 10% shareholders or their affiliates or relatives: a. Issued securities in exchange for property or services . b. Loaned money . c. Rented or purchased property . d. Purchased or sold goods or services . e. No such transactions have occurred . 5. During the last full fiscal year, the issuers officers and directors re ceived combined aggregate cash compensation of: a. Less than $50,000 . b. $50,000 or more but less than $100,000 . c. $100,000 or more but less than $250,000 . d. $250,000 or more but less than $500,000 . e. $500,000 or more . 6. Are there any outstanding options or warrants held by current shareholde rs? YES . NO . 7. Does the issuers liabilities currently exceed the fair market value of its assets? YES . NO . 8. Is the issuer now, or in the past two years was it, unable to meet its o bligations as and when they become due in the usual course of business? YES . NO . 62 American LegalNet, Inc. www.USCourtForms.com
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