Form SEC1808 Form 2-E

You may not send a completed printout of this form to the SEC to satisfy a filing obligation. You can only satisfy an SEC filing obligation by
submitting the information required by this form to the SEC in electronic format online at https://www.onlineforms.edgarἀling.sec.gov.
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

FORM 2-E

OMB APPROVAL
OMB Number:
3235-0233
Expires:
April 30, 2015
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) Total amount received from public from commencement of offering to date ..............................

$ __________

(b) Underwriting discount allowed ................................................................ $ __________
(c) Expenses paid to or for the account of the underwriters .......................... $ __________
(d) 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 information 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*

selling security holder*

Date

* 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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