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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who 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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
10% Senior Secured Promissory Note | $ 0.5 | 09/21/2007 | P | 150,000 | 09/21/2007 | 03/31/2009 | common stock | 150,000 | (1) | 161,500 | D | ||||
Series A-2 Warrant (right to buy) | $ 0.65 | 09/21/2007 | P | 75,000 | 09/21/2007 | 09/21/2012 | common stock | 75,000 | (1) | 236,500 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
BASTANI BAMI |
X |
David W. Robinson, Attorney-in-Fact | 09/24/2007 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | The reporting person invested $75,000 and was issued a Senior Secured Convertible Promissory Note by the Issuer, which note bears interest at 10% per annum (which increases to 12% per annum commencing one year following the issuance date), matures on March 31, 2009, and is convertible into common stock at a conversion rate of $0.50 per share. Interest is payable quarterly, which may be paid by the Issuer with additional senior secured convertible promissory notes. In connection with the reporting person's investment, the Issuer issued the reporting person a Series A-2 warrant to acquire 50% of the shares that would be issuable upon conversion of the reporting person's Senior Secured Convertible Promissory Note. No fee, commission or other compensation of any kind was paid by the Issuer to the reporting person in connection with the reporting person's investment in the Senior Secured Convertible Promissory Note and the Series A-2 Warrant. |