Free Form TH - Federal

File Size: 27.4 kB
Pages: 2
Date: June 30, 2009
File Format: PDF
State: Federal
Category: Government
Author: US SEC
Word Count: 592 Words, 3,945 Characters
Page Size: Letter (8 1/2" x 11")

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Preview Form TH
Washington, D.C. 20549

OMB APPROVAL OMB Number: 3235-0425 Expires: June 30, 2012 Estimated average burden hours per response. . . . . 0.33


________________________________ Report, schedule or registration statement to which the hardship exemption relates (give period of report, if applicable) ______________ CIK of filer or subject company CIK, as applicable _____________________________________________________ Name of Filer or subject company, as applicable ____________ Filed-by CIK (for subject company filings only) _____________________________________________________ Name of "filed-by" entity (for subject company filings only) S-_______________ ________________________________________ (Series identifier(s) and names(s), if applicable; add more lines as needed) C-_______________ ________________________________________ (Class (contract) identifier(s) and names(s), if applicable; add more lines as needed) ___________________________ SEC file number(s) under which filing made (Required, if assigned)

Part I -- Registrant Information

Full Name of Registrant Address of Principal Executive Office Street and Number City, State and Zip Code; Country, if other than US

Part II -- Information Relating to the Hardship

Furnish the following information: 1. A description of the nature and extent of the temporary technical difficulties experienced by the electronic filer in attempting to submit the document in electronic format. 2. A description of the extent to which the electronic filer has successfully submitted documents previously in electronic format with the same hardware and software, in test or required filings.
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.

SEC 2348 (07-06)

3. A description of the burden and expense involved to employ alternative means to submit the electronic submission in a timely manner. 4. Any other reasons why an exemption is warranted.

Part III -- Representation of Intent to Submit Confirming Electronic Copy The filer shall include a representation that it shall cause to be filed a confirming electronic copy of the document filed in paper under cover of the Form TH and that its filing will be in accordance with Rule 201(b) of Regulation S-T (232.201(b) of this chapter) and appropriately designated as a "confirming electronic copy" in accordance with the requirements of the EDGAR Filer Manual.

Part IV -- Contact Person

Name and telephone number, and e-mail address of person to contact in regard to this filing under Form TH:


Area Code Telephone No.

e-mail address

Part V -- Signatures

Name of Filer (if registrant, name as it appears in charter) has caused this Form TH to be signed on its behalf by the undersigned, being duly authorized: Date: By:

Instruction: This form may be signed by an executive officer of the registrant or by any other duly authorized representative.

GENERAL INSTRUCTIONS 1. Rule 201(a) of Regulation S-T (232.201(a) of this chapter) requires electronic filer relying on a temporary hardship exemption to file this Form TH in addition to filing a paper copy of a document otherwise required to be filed in electronic format. 2. Four signed copies of this Form TH must accompany the paper format document being filed pursuant to Rule 201; filers must file under Form TH within one business day after the date upon which the filer was originally to file the document electronically. 3. Signatures to the paper format document being filed with Form TH may be in typed form rather than in manual format. See Rule 302 of Regulation S-T (232.302 of this chapter). Filers must satisfy all other requirements relating to paper format filings, including number of copies to be filed.