SEC 1147 Form 144

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

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FORM 144

SEC USE ONLY
DOCUMENT SEQUENCE NO.

NOTICE OF PROPOSED SALE OF SECURITIES
PURSUANT TO RULE 144 UNDER THE SECURITIES ACT OF 1933
ATTENTION: This form must be filed in electronic format by means of the Commission’s Electronic Data Gathering, Analysis, and
Retrieval system (EDGAR) in accordance with the EDGAR rules set forth in Regulation S-T (17 CFR part 232), except that where the issuer of
the securities is not subject to the reporting requirements of section 13 or 15(d) of the Exchange Act, this form must be filed in accordance with
Securities Act Rule 144(h)(2). For assistance with EDGAR issues, please consult the EDGAR- Information for Filers webpage on SEC.gov.
1 (a) NAME OF ISSUER (Please type or print)

1 (c) ADDRESS OF ISSUER

STREET

2 (a) NAME OF PERSON FOR WHOSE ACCOUNT THE SECURITIES
ARE TO BE SOLD

CITY

WORK LOCATION

(b) S.E.C. FILE NO.

(b) RELATIONSHIP TO
ISSUER

CUSIP NUMBER

STATE

ZIP CODE (d TELEPHONE NO.

area code
number

INSTRUCTION: The filer should contact the issuer to obtain the S.E.C. File Number.
3 (a)

Title of the
Class of
Securities
To Be Sold

INSTRUCTIONS:
1.

2.

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

SEC USE ONLY

(b)
Name and Address of Each Broker Through Whom the
Securities are to be Offered or Each Market Maker
who is Acquiring the Securities

Name of issuer
Issuer’s S.E.C. file number, if any
including

code
Issuer’s address,
zip
number, including

Issuer’s telephone
area code

(a) Name of person for whose account the securities are to be sold

to the issuer
(e.g., officer,
director,
10%
(b) Such person’s
relationship

of any of the foregoing)

stockholder,
or member of immediate
family

Broker-Dealer
File Number

3. (a)
(b)
(c)
(d)
(e)

(f)
(g)

(c)
Number of Shares
or Other Units
To Be Sold
(See instr. 3(c))

(d)

Aggregate
Market
Value
(See instr. 3(d))

(e)
Number of Shares
or Other Units
Outstanding
(See instr. 3(e))

(f)

Approximate
Date of Sale

(g)

(See instr. 3(f))
(MO. DAY YR.)

Name of Each
Securities
Exchange
(See instr. 3(g))

Title of the class of securities to be sold
Name and address of each broker through whom the securities are intended to be sold
Number of shares or other units to be sold (if debt securities, give the aggregate face amount)
Aggregate market value of the securities to be sold as of a specified date within 10 days prior to the filing of this notice
Number of shares or other units of the class outstanding, or if debt securities the face amount thereof outstanding, as shown
by the most recent report or statement published by the issuer
Approximate date on which the securities are to be sold
Name of each securities exchange, if any, on which the securities are intended to be sold

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

SEC1147 (07-22)

TABLE I –– SECURITIES TO BE SOLD

Furnish the following information with respect to the acquisition of the securities to be sold
and with respect to the payment of all or any part of the purchase price or other consideration therefor:
Title of
the Class

Date you
Acquired

INSTRUCTIONS:

Nature of Acquisition Transaction

Name of Person from Whom Acquired
(If gift, also give date donor acquired)

Amount of
Securities Acquired

Date of
Payment

Nature of Payment

If the securities were purchased and full payment therefor was not made in cash at the time of
purchase, explain in the table or in a note thereto the nature of the consideration given. If the
consideration consisted of any note or other obligation, or if payment was made in installments
describe the arrangement and state when the note or other obligation was discharged in full
or the last installment paid.

TABLE II –– SECURITIES SOLD DURING THE PAST 3 MONTHS

Furnish the following information as to all securities of the issuer sold during the past 3 months by the person for whose account the securities are to be sold.
Name and Address of Seller

Title of Securities Sold

Date of Sale

Amount of
Securities Sold

Gross Proceeds

REMARKS:

INSTRUCTIONS:

See the defnition of “person” in paragraph (a) of Rule 144. Information is to be given not only
as to the person for whose account the securities are to be sold but also as to all other persons
included in that defnition. In addition, information shall be given as to sales by all personswhose
sales are required by paragraph (e) of Rule 144 to be aggregated with sales for the account of the
person fling this notic e.

DATE OF NOTICE
DATE OF PLAN ADOPTION OR GIVING OF INSTRUCTION, IF RELYING ON RULE
10B5-1

ATTENTION:

The person for whose account the securities to which this notice relates are to be sold hereby represents by signing
this notice that he does not know any material adverse information in regard to the current and prospective
operations of the Issuer of the securities to be sold which has not been publicly disclosed. If such person has
adopted a written trading plan or given trading instructions to satisfy Rule 10b5-1 under the Exchange Act, by
signing the form and indicating the date that the plan was adopted or the instruction given, that person makes
such representation as of the plan adoption or instruction date.
(SIGNATURE)

The notice shall be signed by the person for whose account the securities are to be sold. At least one copy of the notice shall be manually signed.
Any copies not manually signed shall bear typed or printed signatures.

ATTENTION: Intentional misstatements or omission of facts constitute Federal Criminal Violations (See 18 U.S.C. 1001)
SEC1147 (09-22)