SEC 000 Form SH

OMB Number: 3235-0646
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM SH
FORM SH COVER PAGE
Report for the Period Ended: _____[Month, Day, Year]_______
Check here if Amendment [ ]; Amendment Number: _____
This Amendment (Check only one):
[ ] is a restatement.
[ ] adds new entries.
Institutional Investment Manager Filing this Report:
Name:
Address:

______________________________________
______________________________________
______________________________________
______________________________________

Form 13F File Number: 28-_______________
The institutional investment manager filing this report and the person by whom it is signed hereby represent that the
person signing the report is authorized to submit it, that all information contained herein is true, correct and complete, and
that it is understood that all required items, statements, schedules, lists, and tables, are considered integral parts of this
form.
Person Signing this Report on Behalf of Reporting Manager:
Name: ___________________________
Title: ___________________________
Phone: ___________________________
Signature, Place, and Date of Signing
_______________________________ ____________________
[Signature]
[City, State]

____________
[Date]

Report Type (Check only one):
[]
[]
[]

FORM SH ENTRIES REPORT. (Check here if all entries of this reporting manager are reported in this report.)
FORM SH NOTICE. (Check here if no entries reported are in this report, and all entries are reported by other
reporting manager(s).)
FORM SH COMBINATION REPORT. (Check here if a portion of the entries for this reporting manager is
reported in this report and a portion is reported by other reporting manager(s).)

List of Other Managers Reporting for this Manager:
[If there are no entries in this list, omit this section.]
Form 13F File Number

Name

28-__________________
[Repeat as necessary.]

________________________________________________

OMB Number: 3235-0646
FORM SH SUMMARY PAGE

Report Summary:
Number of Other Included Managers: _____________________
Form SH Information Table Entry Total: _____________________
Form SH Information Table Value Total: _____________________
(thousands)

List of Other Included Managers:
Provide a numbered list of the name(s) and Form 13F file number(s) of all institutional investment managers with respect
to which this Form SH report is filed, other than the manager filing this report.
[If there are no entries in this list, state “NONE” and omit the column headings and list entries.]
No.
____

Form 13F File Number
28-________________________

[Repeat as necessary.]

Name
______________________________________

OMB Number: 3235-0646
FORM SH INFORMATION TABLE –PAGE 1
SUNDAY, _____[Month, Day, Year]_______
Column 1
Name of
Issuer

Column 2

CUSIP

Column 3

Short
Position
(Start of
Day)

Column 4
Number of
Securities
Sold Short
(Day)

Column 5

Value of
Securities
Sold Short
(Day)
(x $1000)

Column 6
Short
Position
(End of
Day)

Column 7
Largest
Intraday
Short
Position

Column 8
Time of Day
of Largest
Intraday
Short
Position

OMB Number: 3235-0646
FORM SH INFORMATION TABLE –PAGE 2
MONDAY, _____[Month, Day, Year]_______
Column 1
Name of
Issuer

Column 2

CUSIP

Column 3

Short
Position
(Start of
Day)

Column 4
Number of
Securities
Sold Short
(Day)

Column 5

Value of
Securities
Sold Short
(Day)
(x $1000)

Column 6
Short
Position
(End of
Day)

Column 7
Largest
Intraday
Short
Position

Column 8
Time of Day
of Largest
Intraday
Short
Position

OMB Number: 3235-0646
FORM SH INFORMATION TABLE –PAGE 3
TUESDAY, _____[Month, Day, Year]_______

Column 1
Name of
Issuer

Column 2

Column 3

CUSIP

Short
Position
(Start of
Day)

Column 4
Number of
Securities
Sold Short
(Day)

Column 5

Value of
Securities
Sold Short
(Day)
(x $1000)

Column 6
Short
Position
(End of
Day)

Column 7
Largest
Intraday
Short
Position

Column 8
Time of Day
of Largest
Intraday
Short
Position

OMB Number: 3235-0646
FORM SH INFORMATION TABLE –PAGE 4
WEDNESDAY, _____[Month, Day, Year]_______
Column 1
Name of
Issuer

Column 2

CUSIP

Column 3

Short
Position
(Start of
Day)

Column 4
Number of
Securities
Sold Short
(Day)

Column 5

Value of
Securities
Sold Short
(Day)
(x $1000)

Column 6
Short
Position
(End of
Day)

Column 7
Largest
Intraday
Short
Position

Column 8
Time of Day
of Largest
Intraday
Short
Position

OMB Number: 3235-0646
FORM SH INFORMATION TABLE –PAGE 5
THURSDAY, _____[Month, Day, Year]_______
Column 1
Name of
Issuer

Column 2

CUSIP

Column 3

Short
Position
(Start of
Day)

Column 4
Number of
Securities
Sold Short
(Day)

Column 5

Value of
Securities
Sold Short
(Day)
(x $1000)

Column 6
Short
Position
(End of
Day)

Column 7
Largest
Intraday
Short
Position

Column 8
Time of Day
of Largest
Intraday
Short
Position

OMB Number: 3235-0646
FORM SH INFORMATION TABLE –PAGE 6
FRIDAY, _____[Month, Day, Year]_______
Column 1
Name of
Issuer

Column 2

Column 3

CUSIP

Short
Position
(Start of
Day)

Column 4
Number of
Securities
Sold Short
(Day)

Column 5

Value of
Securities
Sold Short
(Day)
(x $1000)

Column 6
Short
Position
(End of
Day)

Column 7
Largest
Intraday
Short
Position

Column 8
Time of Day
of Largest
Intraday
Short
Position

OMB Number: 3235-0646
FORM SH INFORMATION TABLE –PAGE 7
SATURDAY, _____[Month, Day, Year]_______
Column 1
Name of
Issuer

Column 2

CUSIP

Column 3

Short
Position
(Start of
Day)

Column 4
Number of
Securities
Sold Short
(Day)

Column 5

Value of
Securities
Sold Short
(Day)
(x $1000)

Column 6
Short
Position
(End of
Day)

Column 7
Largest
Intraday
Short
Position

Column 8
Time of Day
of Largest
Intraday
Short
Position