WPC /=,VbK<"n]rf "&T&w8xcTp/;pm~%51[ӂIM'(QxeB!l,6ebب5\7Q8I+m3 `0鄮a6<O~)>cG{)KB;[q (iyk] U>T  n 0 N& w@( 4h ^ | UJ #! UJUJ= m B<6X9`("Courier 10cpiX'     0 .   Page 1 of 2 ; DEPARTMENT OF COMMERCE ; UTAH SECURITIES DIVISION ; FORM 14.2n 1 ; Limited Offering Exemption Notification ; ( ) Progress Report ( ) Rule R177 14 2n(5); ( ) Final Report ( ) Rule R177 14 2n(6); Date: ; 1. Name of Issuer: ; 2. Address of Issuer: ; City: State: Zip Code: ; 3.* `&CG Times 10ptWP* `&CG Times 12ptWP3|C<6X9`("Courier 10cpiXx6X@8;X@* `&CG Times 10ptWPd P[+GP* `&CG Times 12ptWPXXw PS+GXP(Y${{  SXXX UPPD P S S S D[*Z-'-$%-')Z  Z 2CG Times (W1) RegularHP LaserJet 5Si/5Si MX,,,,,,0)Z  Z 2CG Times (W1) Regular)Z  Z 2CG Times (W1) RegularU d !{{  S .RXX  XS)dRRS .&%RS)d_Page1of3 +    3      ;      C (Rev.2/9/90)  @FSTATEOFUTAH@ADEPARTMENTOFCOMMERCE@ADIVISIONOFSECURITIES@GFORM1021&%%&Ԉ  Q @ 6 ApplicationforRegistrationbyQualification   . 1.    NameofIssuer   3      ;     Phone C   "      '#'#]# @+  @+  @+  @+  u   Ѐ  ]#]#]# @+  R     Street +    3   City&State ;     ZipCode /  2.  NameofApplicant  3      ;     Phone C   "  9      ]#]#]# @+ @]#]#]#@]#]#]# @+   Street +    3   City&State ;     ZipCode   3.  NameofCorrespondent 3      ;     Phone C   "  :      +    3      ;      C   " ]#]#]#  Street +    3   City&State ;     ZipCode ! 4.  AgentorUnderwriter  3      ;     Phone C   "     ]#]#]# @+   Street +    3   City&State ;     ZipCode "r 5.  TransferAgent   3      ;     Phone C   "  ,   ]#]#]#@]#]#]# @+   Street +    3   City&State ;     ZipCode s 6.  DescriptionofSecuritiestobeofferedinUtah]#]#]# -!}!   NumberofSharesorUnitstobeoffered  ]#]#]# "7#   Class +    3     ]#]#]#@@L $%    +    3 ]#]#]# ~% &   ProposedOfferingPriceperShareorUnit  ]#]#]# [&!'   AmountinDollars  3     ]#]#]# (e#) 7.0  a. + Listthestates,otherthanUtah,inwhichtheissuerorapplicantproposestoofferthe)%+]#]#   securitiesforsaletothepublic:     ;      C   "  +&- 0   ]#]#   &%%& /*+2  Q0+3 ЇPage2of3  Form1021#&E&&&E#  b.  Listthestatesinwhichthesecuritiesareeligibleforsaletothepublic:   C   "  A      +    3      ;      C   "   8.  MaximumCommissiontobepaid     ;      C   "    9.0  Listnameandresidentialaddressofalldirectorsorofficersorpartnersoftheissuerorindividuals >   whoownofrecordorbeneficially10%ormoreoftheoutstandingsharesofanyclassofequitysecuritiesoftheissuer: ]#]#   Name@HAddress       ]#]#]# `    ]#]#]# f   ]#]#]#    ]#]#]#  ]#]#]#10.  EscrowAgent   3      ;      C  '#'#]#  @C  @  @"  8    +    3 (NameofFinancialInstitution)  Escrowperiod   3      ;       C    ]#]#]#  @"   11.  Theissuer'sfiscalyearends 3      ;      C   ]#]#]#  @"   12.0  Arethere(orhavetherebeen)anycriminalorcivilcomplaints,orinvestigationsbytheSEC, 5 NASD,orotherStateSecuritiesDepartment,coveringthecompanyoranyofitsofficers? ]#]#   Yes + No 󀀀Ifanswerisyes,explain:]#]#]# !"   X^X&&E  ]#]#]# |#$   ]#]#]# ^% & X^XXX^&E&XX^13.0  TheapplicantherebyappliesforregistrationofsecuritiesunderSection61110oftheUtahUniform @'"( SecuritiesActandinconsiderationthereofagrees: ]#]#   (a)0 + Aftereitherthecloseoftheofferingortheexpirationofeffectivenessoftheregistration )!%+ statement,whicheveroccursfirst,applicantshallfilewithin10businessdaysofarequestoftheDivision,alistofpurchasersintheoffering,theresidentialaddressofeachpurchaser,theamountofsecuritiespurchasedandtheconsideration &E&&&Epaidbyeachpurchaser;b,'.+ ]#+ ]# #&E&& &E#&E&&&E /+2 Ї  Page3of3  Form1021#&E&&&E#     +   (b)0 + AllamendmentstotheprospectuswillbepromptlyfiledwiththeDivision,distributedto l purchasersintheoffering,andmadeapartofanyprospectususedthereafter; + ]#+ ]# &E&&&E  (c)0 + TheDivision,marketmakersandsecurityholderswillbepromptlynotifiedinwritingof   anychangeinthemanagement,purpose,andcontroloftheissuer,oranymaterialoradverseconditionaffectingtheissuer,solongastheregistrationstatementiseffective; + ]#+ ]#   (d)0 + FinancialstatementswillbesubmittedtotheDivisioninaccordancewithparagraphH.of i  R164102. + ]#+ ]# 14.0  Theapplicantherebyaffirmsthatnomaterialcontract,understandingoragreementexistswhichis   notreflectedintheregistrationstatement. ]#]# Stateof +    3 ) ;    +    3 )ss.Countyof +    3 ) A   Theundersigned,  3   ,beingfirstdulysworn,deposesandsaysthathehas  executedtheforegoingapplicationforandonbehalfoftheapplicant,thatheisthe C  of "     suchapplicantandisfullyauthorizedtoexecuteandfilesuchapplication;thatheisfamiliarwith ] suchapplication;andthattothebestofhisknowledge,informationandbelief,thestatementsmadeinsuchapplicationaretrueandthedocumentssubmittedherewitharetruecopiesoftheoriginalthereof.   +    3      ;      C   "    +    3 SignatureSubscribedandsworntobeforemethis    dayof     C  ,19 "  Z    +    3    +    3 NotaryPublic   ;      C   "   `     +    3 MyCommissionExpires     C   "  !"   Theundersigneddirectors,officers,partnerorpartnersoftheissuernamedhereindoherebyaffirmthattheyhavereadthisregistrationstatementandallexhibitsthereto,andthatthecontentsthereofaretruetothebestoftheirknowledgeandbelief;andfurtherthat(correspondent)  񀀀 C  ishereby 2% & authorizedtoexecutethisregistrationstatementonbehalfoftheissuer,andcontinuingauthorityisherebydelegatedtohimtofileanyamendments,supplementaryorperiodicinformationtheretoasmaybeapplicableorrequired,pursuanttotheUtahUniformSecuritiesAct,andrulespromulgatedthereunder.Signature@L  Title y)$+    +    3      ;      C   "  /+&-    +    3      ;      C   "