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Securities and Exchange Commission (SEC) - Form3

This document is a Form 3 filing with the United States Securities and Exchange Commission. It provides information about a reporting person who has acquired beneficial ownership of securities. The form includes sections for the reporting person's contact information, details about the securities acquired like title and amount, as well as certification of the provided information. It requires submission within 10 days of acquiring beneficial ownership of securities.

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0% found this document useful (0 votes)
106 views

Securities and Exchange Commission (SEC) - Form3

This document is a Form 3 filing with the United States Securities and Exchange Commission. It provides information about a reporting person who has acquired beneficial ownership of securities. The form includes sections for the reporting person's contact information, details about the securities acquired like title and amount, as well as certification of the provided information. It requires submission within 10 days of acquiring beneficial ownership of securities.

Uploaded by

highfinance
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

UNITED STATES SECURITIES AND EXCHANGE COMMISSION

FORM 3 Washington, D.C. 20549


Form 3
OMB APPROVAL
OMB Number: 3235-0104
Expires: January 31, 2008
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Estimated average burden
hours per response. . . . . . 0.5
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility
(Print or Type Responses) Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940

1. Name and Address of Reporting Person* 2. Date of Event 3. Issuer Name and Ticker or Trading Symbol
Requiring Statement
(Month/Day/Year)
(Last) (First) (Middle) 4. Relationship of Reporting Person(s) to Issuer 5. If Amendment, Date
(Check all applicable)
Original Filed (Month/Day/
Year)
Director 10% Owner
(Street) Officer (give Other (specify 6. Individual or Joint/Group
title below) below) Filing (Check Applicable Line)
__Form filed by One Reporting Person
__Form filed by More than One ReportingPerson
(City) (State) (Zip)
Table I — Non-Derivative Securities Beneficially Owned

1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial Ownership


(Instr. 4) Beneficially Owned Form: Direct (Instr. 5)
(Instr. 4) (D) or Indirect
(I) (Instr. 5)

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5(b)(v).
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. (Over)
SEC 1473 (1-05)
FORM 3 (continued) Table II — Derivative Securities Beneficially Owned ( e.g., puts, calls, warrants, options, convertible securities)

1. Title of Derivative Security 2. Date Exer- 3. Title and Amount of Securities Underlying 4. Conver- 5. Owner- 6. Nature of Indirect
(Instr. 4) cisable and Derivative Security sion or ship Beneficial Ownership
Expiration (Instr. 4) Exercise Form of (Instr. 5)
Date Price of Deriv-
(Month/Day/Year) Deri- ative
vative Security:
Date Expira- Amount Direct
or Security
Exer- tion (D) or
cisable Date Title Number Indirect
of (I)
Shares (Instr. 5)

Explanation of Responses:

** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. **Signature of Reporting Person Date
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
See Instruction 6 for procedure.

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 Number.

Page 2

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