Report Of Offering Solely To Accredited Investors {3-Y}

FORM 3-Y - NOTICE OF PROPOSED PUBLIC OFFERING SOLELY TO ACCREDITED INVESTORS MODEL ACCREDITED INVESTORS EXEMPTIONS 1707.03(Y). This form to be used only for any offer and sale of securities made solely to accredited investors, as defined in Rule 501 of regulation D under the Securities Act of 1933, made in reliance on the exemption under R.C. 1707.03(Y). This form, with a $100 filing fee and the required exhibits, must be submitted to the Ohio Division of Securities, 77 S. High Street, 22nd Floor, Columbus, OH 43215-6131 within fifteen days of the first use of a general announcement of the offering. Note: This form may not be filed in connection with offerings exempt under R.C. 1707.03(Q), (W) or (X). www.FormsWorkflow.com