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Form For Use In Filling Quarterly Reports Required By Rule S4 For Securities Registered By Notification Or Qualification S4 - Puerto Rico

Form For Use In Filling Quarterly Reports Required By Rule S4 For Securities Registered By Notification Or Qualification Form. This is a Puerto Rico form and can be used in Securities Blue Sky Commissioner Of Financial Institutions .
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Form S-4 Rev. 03-13 COMMONWEALTH OF PUERTO RICO COMMISSIONER OF FINANCIAL INSTITUTIONS Centro Europa Building, Suite 600 1492 Ponce de León, Ave. San Juan, P.R. 00907-4127 Tel. (787) 723-8403 Fax (787) 724-2604 FORM FOR USE IN FILING QUARTERLY REPORTS REQUIRED BY ARTICLE 38 OF THE REGULATION UNDER DE UNIFORM SECURITIES ACT OF PUERTO RICO FOR SECURITIES REGISTERED BY NOTIFICATION OR QUALIFICATION 1. Name of Applicant and file number of the registration statement _________________ _______________________________________________________________________ 2. 3. Name of Issuer __________________________________________________________ Name of underwriter, if any ________________________________________________ _______________________________________________________________________ 4. Date of this report ________________________________________________________ _______________________________________________________________________ 5. (a) (b) (c) Date offering commenced ___________________________________________ Date offering completed, if completed _________________________________ If offering has not commenced, state reasons briefly _____________________ ________________________________________________________________ 6. (a) (b) Total number of shares or other units offered ___________________________ Number of such shares or other units sold from commencement of offering to date___________________________. Number of shares or other units still being offered _______________________ Total number of shares or other units offered in Puerto Rico_______________ Number of such shares or other units sold in Puerto Rico __________________ Number of shares or other units still being offered in Puerto Rico ___________ (c) 7. (a) (b) (c) American LegalNet, Inc. www.FormsWorkFlow.com Form S-4 Page 2 8. (a) (b) (c) (d) Total amount received from public since comencement of offering to date $____ Underwriting discount allowed $___________ Expenses paid to or for the account of the underwriters $___________ Other expenses paid to date by or for the account of the issuer: (1) (2) (3) (4) (5) Legal (including organization) Accounting Engineer's fees incurred Prior to offering Printing and advertising Other $____________ $____________ $____________ $____________ $____________ $___________ $___________ (e) (f) 9. Total costs and expenses (b), (c) and (d) Proceeds to issuer after such deductions (a) minimum (3) Use of net proceeds from commencement of offering to date: Payment to Directors and Affiliates (a) (b) (c) (d) (e) Salaries and fees Purchase of real estate Purchase and installation of machinery and equipment Construction of plant building and facilities Development expense (product development research, patent costs, etc.) Purchase of raw materials, Inventories, supplies, etc. Selling, advertising, and other sales promotion $ $ $ $ Payment to others $______ $______ $______ $______ $ $ $ $______ $______ $______ (f) (g) Instruction: Item 9 of this form need not be completed unless the securities registered are being offered on behalf of the issuer. 10. State briefly the nature and extent of each type of the issuer's principal activities to date ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Form S-4 Page 3 11. State whether the offering has been discontinued, and if so, state the date and describe briefly the reasons for such discontinuance. ________________________________________________________________________ ________________________________________________________________________ 12. List the names and addresses of all brokers and dealers who have, to the knowledge of the issuer or underwriters, participated in the distribution of the securities offered during the period covered by this report. ________________________________________________________________________ ________________________________________________________________________ Instructions: In reports made subsequent to the initial report, the information needs to be given only with respect to persons not previously reported. 13. State the number of shares held by each promoter, director, officer or controlling person of the issuer, if different from the amount stated in the prospectus. Date ________________________________ Issuer __________________________ By ____________________________ Name and title _______________________________ Selling security holder ________________________________ Applicant registering securities American LegalNet, Inc. www.FormsWorkFlow.com
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