Form SEC1808 Form 2-E

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 2-E

OMB APPROVAL
OMB Number:
3235-0233
Expires:
June 30, 2012
Estimated average burden
hours per response. . . . . .4.00

REPORT PURSUANT TO RULE 609 OF REGULATION E
1.

Name of issuer

2.

Name of underwriter

3.

Date of this report

4.

(a) Date offering commenced
(b) Date offering completed, if completed
(c) If offering has not commenced, state reasons briefly

5.

(a) Total number of shares or other units offered hereunder
(b) Number of such shares or other units sold from commencement of offering to date
(c) Number of such shares or other units still being offered

6.

(a)
(b)
(c)
(d)

Total amount received from public from commencement 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) Legal (including organization) ......................................................................................... $

(2) Accounting ......................................................................................................................... $

(3) Printing and advertising .................................................................................................... $

(4) Other ................................................................................................................................... $

(e) Total costs and expenses ((b), (c) and (d)) ...................................................................................................
(f) Proceeds to issuer after above deductions ((a) minus (e)) ..........................................................................

$

$

$

7.

State briefly the nature and extent of each type of the issuer’s principal activities to date.

8.

State whether the offering has been discontinued, and if so, state the date and describe briefly the reasons for such discontinuance.

9.

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.

Instruction. In reports made subsequent to the initial report, the information need be given only with respect to persons not previously
reported.
SEC’s Collection of Information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid control number. Filing of this Form is mandatory. This form is used by a small business
investment company that has engaged in a limited offering of its securities to report semiannually to the Commission on the progress
of the offering, including the number of shares sold. The Commission estimates that the burden for completing the Form will be
approximately 4 hours per filing. Any person may direct to the Commission any comments concerning the accuracy of the burden
estimate of this Form and any suggestions for reducing this burden. This collection of information has been reviewed by the Office
of Management and Budget in accordance with the clearance requirements of 44 U.S.C. § 3507. The responses to the collection of
information will not be kept confidential.

SEC 1808 (10-06)

Potential persons who are to respond to the collection of infor
mation contained in this form are not required to respond
unless the form displays a currently valid OMB control number.

(Issuer)*
Date

By
(Name and Title)*

Date

(Selling Security Holder)*

*At least one copy of the report shall be signed manually by each person whose signature is required. Any copies not manually signed shall
bear typed or printed signatures.

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