-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, URyyznxeLEYzMmyfRnPp2WUQc6B1+UKVYIyMoy1LFR9RcXynA1B8wriwydkiIr9r tfewrHf/NYz/qeYxSY1kaQ== 0001072588-11-000014.txt : 20110128 0001072588-11-000014.hdr.sgml : 20110128 20110127185559 ACCESSION NUMBER: 0001072588-11-000014 CONFORMED SUBMISSION TYPE: 8-K PUBLIC DOCUMENT COUNT: 3 CONFORMED PERIOD OF REPORT: 20101231 ITEM INFORMATION: Entry into a Material Definitive Agreement ITEM INFORMATION: Completion of Acquisition or Disposition of Assets ITEM INFORMATION: Unregistered Sales of Equity Securities ITEM INFORMATION: Financial Statements and Exhibits FILED AS OF DATE: 20110128 DATE AS OF CHANGE: 20110127 FILER: COMPANY DATA: COMPANY CONFORMED NAME: GOLDEN DRAGON HOLDING CO. CENTRAL INDEX KEY: 0001081938 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 274635140 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 8-K SEC ACT: 1934 Act SEC FILE NUMBER: 000-27055 FILM NUMBER: 11553321 BUSINESS ADDRESS: STREET 1: 2460 W. 26TH AVENUE, SUITE 380-C CITY: DENVER STATE: CO ZIP: 80211 BUSINESS PHONE: 303-380-8280 MAIL ADDRESS: STREET 1: 2460 W. 26TH AVENUE, SUITE 380-C CITY: DENVER STATE: CO ZIP: 80211 FORMER COMPANY: FORMER CONFORMED NAME: CCVG, INC. DATE OF NAME CHANGE: 20101117 FORMER COMPANY: FORMER CONFORMED NAME: CONCORD VENTURES, INC. DATE OF NAME CHANGE: 20071003 FORMER COMPANY: FORMER CONFORMED NAME: CAVION TECHNOLOGIES INC DATE OF NAME CHANGE: 19990423 8-K 1 gdhc8kresaleofccaps.txt UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 8-K Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 Date of earliest event reported: December 31, 2010 GOLDEN DRAGON HOLDING CO. ----------------------------- (Exact name of registrant as specified in its charter) Delaware ------------ (State or other jurisdiction of incorporation) 000-27055 27-4635140 - --------------------------- ------------- (Commission File Number) (I.R.S. Employer Identification No.) 2460 W. 26th Avenue, Suite 380-C, Denver, Colorado 80211 ---------------------------------------------------------- (Address of principal executive offices) (Zip Code) Registrant's telephone number, including area code: (303) 380-8280 CCVG, INC. -------------- (Former name, former address and former fiscal year, if changed since last report) Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions. [_] Written communications pursuant to Rule 425 under the Securities Act (17 CFR240.14d-2(b)) [_] Soliciting material pursuant to Rule 14a-12 under Exchange Act (17 CFR240.14a-12) [_] Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR240.14d-2(b)) [_] Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR240.13e-4(c)) SECTION 1 - REGISTRANT'S BUSINESS AND OPERATIONS ITEM 1.01 ENTRY INTO A MATERIAL DEFINITIVE AGREEMENT Reorganization into a Holding Company Structure Effective December 31, 2010, pursuant to the Delaware Holding Company formation statute, DGCL Section 251(g), CCVG, Inc. ("CCVG") completed an Agreement and Plan of Merger and Reorganization into a Holding Company ("the Agreement") with CCaps Co. ("CCaps ") and Golden Dragon Holding Co. ("Golden Dragon"), both wholly-owned subsidiaries of CCVG. The Agreement provided for the merger of CCVG with and into CCaps, with CCaps being the surviving corporation in that merger. Contemporaneously with CCVG's merger with and into CCaps pursuant to the Holding Company formation (and the Agreement), the shareholders of CCVG were converted, to shareholders of Golden Dragon on a one for one basis pursuant to the Agreement. As a result of this reorganization into a Holding Company structure, Golden Dragon became the publicly quoted parent holding company with CCaps, the surviving corporation of the merger between CCVG and CCaps, becoming the sole remaining wholly-owned subsidiary of Golden Dragon. On December 31, 2010, Golden Dragon entered into a Share Purchase Agreement with James Clark. Under the terms of the Share Purchase Agreement, Golden Dragon sold 100% of the issued and outstanding shares of its sole remaining wholly owned subsidiary, CCaps, to James Clark for $100 cash consideration, subject to its debts, and issued 25,000 shares of Golden Dragon Common Stock, valued at $1,000, to CCaps pursuant to the terms of the Share Purchase Agreement. At the time of the sale, CCaps had no ongoing operations or assets and outstanding liabilities of approximately $678,000. SECTION 2 - FINANCIAL INFORMATION ITEM 2.01 - COMPLETION OF ACQUISITION OR DISPOSITION OF ASSETS Sale of Subsidiary On December 31, 2010, 100% of the issued and outstanding shares of CCaps the sole remaining wholly-owned subsidiary of Golden Dragon, was sold to an unrelated third party in exchange for $100 cash consideration, subject to its debts, and the issue of 25,000 shares of Golden Dragon Common Stock to CCaps. At the time of the sale, CCaps had no ongoing operations or assets and outstanding liabilities of approximately $678,000. Following the merger of CCVG with and into CCaps , CCaps, as the surviving corporation in that merger, retained all outstanding liabilities of CCVG in the divestiture. As a result of the sale of 100% of the issued and outstanding shares of CCaps, the holding company, Golden Dragon will no longer consolidate liabilities of CCaps or CCVG. 2 SECTION 3 - SECURITIES AND TRADING MATTERS ITEM 3.02 UNREGISTERED SALES OF EQUITY SECURITIES On December 31, 2010, Golden Dragon issued 25,000 shares of Common Stock to CCaps in accordance with the terms of the Share Purchase Agreement, in a transaction exempt from registration under Section 4(2) of the Securities Act of 1933. SECTION 9 - FINANCIAL STATEMENTS AND EXHIBITS ITEM 9.01 FINANCIAL STATEMENTS AND EXHIBITS a) Financial Statements - Not Applicable b) Exhibits - 10.1 Agreement and Plan of Merger and Reorganiza- tion into a Holding Company 10.2 Share Purchase Agreement 3 SIGNATURES Pursuant to the requirements of the Securities Exchange Act of 1934, as amended, the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized. GOLDEN DRAGON HOLDING CO. (Registrant) Dated: January 26, 2011 /s/ David J. Cutler ----------------------------------- David J. Cutler, President 4 EX-10.1 2 ex10-1.txt EXHIBIT 10.1 AGREEMENT AND PLAN OF MERGER AND REORGANIZATION INTO HOLDING COMPANY STRUCTURE THIS AGREEMENT AND PLAN OF MERGER AND REORGANIZATION INTO HOLDING COMPANY STRUCTURE (this "Agreement"), dated as of December 31, 2010, is between CCVG, Inc., a Delaware corporation ("CCVG"), and Ccaps Co., a Delaware corporation that is a wholly-owned subsidiary of CCVG, Inc. ("Ccaps"), as constituent corporations, and Golden Dragon Holding Co., a Delaware corporation ("Hold Co.") that is another wholly-owned subsidiary of CCVG, joins this Agreement, but Hold Co. is not a "constituent corporation." WHEREAS, on the date hereof, CCVG has authority to issue 110,000,000 shares of stock, $0.0001 par value per share, consisting of 100,000,000 common shares (the "CCVG Common Stock") and 10,000,000 Preferred Shares (the "CCVG Preferred Stock"), of which 2,359,407 shares of CCVG Common Stock are issued and outstanding, and no shares of CCVG Preferred Stock of any class or series are issued and outstanding. WHEREAS, on the date hereof, Ccaps has authority to issue 110,000,000 shares of stock, $0.0001 par value per share, 100,000,000 common shares (the "Ccaps Common Stock") and 10,000,000 Preferred Shares (the "Ccaps Preferred Stock"), of which 1,000 shares of Ccaps Common Stock are issued, outstanding and owned by CCVG, and no shares of Ccaps Preferred Shares of any class or series are issued and outstanding. WHEREAS, on the date hereof, Hold Co. has authority to issue 110,000,000 shares of stock, $0.0001 par value per share, consisting of 100,000,000 common shares (the "Hold Co. Common Stock") and 10,000,000 Preferred Shares (the "Hold Co. Preferred Stock"), of which 1,000 shares of Hold Co. Common Stock are issued, outstanding and owned by CCVG, and no shares of Hold Co. Preferred Stock of any class or series are issued and outstanding; WHEREAS, the respective Boards of Directors of CCVG and Hold Co. have determined that it is advisable and in the best interests of each of such corporations that they reorganize into a holding company structure pursuant to Section 251(g) of the Delaware General Corporation Law, pursuant to a merger (the "Reorganization Merger") between CCVG and Ccaps in which Ccaps would survive and become a wholly-owned subsidiary of Hold Co. by virtue of the conversion pursuant to the Reorganization Merger of each share of CCVG Common Stock into a share of Hold Co. Common Stock; WHEREAS, under the respective certificates of incorporation of CCVG, as amended to date, and Hold Co., the CCVG Common Stock has the same designations, rights and powers and preferences, and the qualifications, limitations and restrictions thereof, as the Hold Co. Common Stock into which the issued and outstanding CCVG Common Stock will be converted therefore pursuant to the Reorganization Merger; WHEREAS, the certificate of incorporation and Bylaws of Hold Co., as the holding company immediately following the Reorganization Merger, contains provisions that are substantially identical to the certificate of incorporation and Bylaws of CCVG, each as amended to date, immediately prior to the merger, other than such differences as are permitted by Section 251(g) of the Delaware General Corporation Law; 1 WHEREAS, the certificate of incorporation of CCVG, as amended to date, is substantially identical to the certificate of incorporation of Ccaps, immediately prior to the Reorganization Merger, other than such differences as are permitted by Section 251(g) of the Delaware General Corporation Law; WHEREAS, the Boards of Directors of Hold Co., Ccaps and CCVG, as sole stockholder of each of Hold Co. and Ccaps, have approved this Agreement; WHEREAS, the Board of Directors of CCVG have approved this Agreement, and shareholder approval is not required pursuant to Section 251(g) of the Delaware General Corporation Law; WHEREAS, the parties hereto intend that the Reorganization Merger contemplated by this Agreement shall constitute a tax-free reorganization pursuant to Section 368(a) (1) of the Internal Revenue Code; NOW, THEREFORE, in consideration of the mutual agreements and covenants herein contained, CCVG and Ccaps, as the constituent companies, and Hold Co., as the designated holding company, hereby agree as follows: 1. Succession. (a) Holding Company. At the Effective Time, by virtue of the transactions described in Sections 2 and 6, Hold Co. shall become the holding company of Ccaps, the surviving corporation of the merger of CCVG with and into Ccaps pursuant to Section 251(g) (3) and (4) of the Delaware General Corporation Law. (b) Company Consolidation. At the Effective Time, the separate corporate existence of CCVG shall cease, and Ccaps shall succeed to all of the assets and property (whether real, personal or mixed), rights, privileges, franchises, immunities and powers of CCVG, and Ccaps shall assume and be subject to all of the duties, liabilities, obligations and restrictions of every kind and description of CCVG, including, without limitation, all outstanding indebtedness of CCVG, all in the manner and as more fully set forth in Sections 251(g) and 259 of the Delaware General Corporation Law. 2. Merger. Pursuant to the Reorganization Merger, CCVG shall be merged with and into Ccaps and Ccaps shall be the surviving corporation (hereinafter sometimes referred to as the "Surviving Corporation"). The Reorganization Merger shall become effective upon December 31, 2010 after filing of this Merger Agreement with the Secretary of State of the State of Delaware in accordance with Section 251(g) of the Delaware General Corporation Law, (the "Effective Time"). 3. Certificate of Incorporation of the Surviving Corporation. The certificate of incorporation of Ccaps which, as in effect immediately prior to the Effective Time, contains provisions substantially identical to the certificate of incorporation of CCVG, as amended and in effect immediately prior to the Effective Time, shall continue in full force and effect as the certificate of incorporation of the Surviving Corporation, except as amended as set forth below, until further amended as provided therein and under the Delaware General Corporation Law. 2 (a) A new Article Sixth shall be added to the certificate of incorporation of the Surviving Corporation, which reads as follows: "SIXTH. Any act or transaction by or involving the Corporation, other than the election or removal of directors, that requires for its adoption under the Delaware General Corporation Law or under this Certificate of Incorporation the approval of the Corporation's stockholders shall, pursuant to Section 251(g) of the Delaware General Corporation Law, require, in addition, the approval of the stockholders of the Corporation's holding company, Asiana Dragons, Inc., or any successor by merger, by the same vote as is required by the Delaware General Corporation Law and/or by the Certificate of Incorporation of the Corporation." 4. Directors. The directors of CCVG immediately prior to the Effective Time are and shall remain the directors of the Surviving Corporation and Hold Co. immediately after the Effective Time, to serve until the expiration of their respective terms and until their successors are duly elected and qualified. 5. Officers. The officers of CCVG immediately preceding the Effective Time are and shall remain the officers of the Surviving Corporation and Hold Co. immediately after the Effective Time, to serve at the pleasure of the Board of Directors of the respective corporations. 6. Conversion of Securities. At the Effective Time, by virtue of the Reorganization Merger and without any action on the part of the holder thereof: (a) each share of CCVG Common Stock issued and outstanding immediately prior to the Effective Time shall be changed and converted into one fully paid and nonassessable share of Hold Co. Common Stock; (b) each share of CCVG Common Stock held in the treasury of CCVG immediately prior to the Effective Time shall be cancelled and retired; (c) each option, warrant, purchase right, unit or other security of CCVG convertible into shares of CCVG Common Stock shall become convertible into the same number of shares of Hold Co. Common Stock as the holder of such security would have received if the security had been converted into shares of CCVG Common Stock immediately prior to the Effective Time, and Hold Co. shall reserve for purposes of the exercise of such options, warrants, purchase rights, units or other securities an equal number of shares of Hold Co. Common Stock as the number of shares of CCVG Common Stock that CCVG had reserved for issuance as of the moment immediately prior to the Effective Time; and (d) each share of Ccaps Common Stock and each share of Hold Co. Common Stock issued and outstanding in the name of CCVG immediately prior to the Effective Time shall be cancelled and retired and resume the status of authorized and unissued shares of Ccaps Common Stock and Hold Co. Common Stock, respectively. 7. Other Agreements to Issue Stock. At the Effective Time, Hold Co. shall assume any obligation of CCVG to deliver or make available shares of CCVG Common Stock under any agreement or employee benefit plan to which CCVG is a party. Any reference to CCVG Common Stock under any such agreement or employee benefit plan shall be deemed to be a reference to Hold Co. Common Stock and one share of Hold 3 Co. Common Stock shall be issuable in lieu of each share of CCVG Common Stock required to be issued by any such agreement or employee benefit plan, subject to subsequent adjustment as provided in any such agreement or employee benefit plan. 8. Hold Co. as Successor to CCVG. It is the intent of the parties hereto, and the parties hereto shall ensure that Hold Co., as of the Effective Time, be deemed a "successor issuer" for purposes of Rule 12g-3(a) under the Securities Exchange Act of 1934, as amended (the "Exchange Act"). 9. Further Assurances. From time to time, as and when required by the Surviving Corporation or by its successors or assigns, there shall be executed and delivered on behalf of CCVG such deeds and other instruments, and there shall be taken or caused to be taken by it all such further and other action, as shall be appropriate, advisable or necessary in order to vest, perfect or conform, of record or otherwise, in the Surviving Corporation, the title to and possession of all property, interests, assets, rights, privileges, immunities, powers, franchises and authority of CCVG, and otherwise to carry out the purposes of this Agreement, and the officers and directors of the Surviving Corporation are fully authorized, in the name and on behalf of CCVG or otherwise, to take any and all such action and to execute and deliver any and all such deeds and other instruments. 10. Certificates. At and after the Effective Time, all of the outstanding certificates which immediately prior thereto represented shares of CCVG Common Stock shall be deemed for all purposes to evidence ownership of and to represent the shares of Hold Co. Common Stock, as the case may be, into which the shares of CCVG Common Stock represented by such certificates have been converted as herein provided and shall be so registered on the books and records of Hold Co. and its transfer agent; provided that Hold Co. shall, following the Effective Time, cause its transfer agent to demand that the stockholders surrender the certificates which previously represented CCVG Common Stock in exchange for new stock certificates representing share of Hold Co. Common Stock. The registered owner of any previously outstanding certificate shall, until such certificate shall have been surrendered for transfer or otherwise accounted for to Hold Co. or its transfer agent, have and be entitled to exercise any voting and other rights with respect to, and to receive any dividends and other distributions upon, the shares of Hold Co. Common Stock, as the case may be, evidenced by such outstanding certificate, as above provided. 11. Amendment. The parties hereto, by mutual consent of their respective Boards of Directors, may amend, modify or supplement this Agreement prior to the Effective Time. 12. Compliance with Section 251(g) of the Delaware General Corporation Law. Prior to the Effective Time, the parties hereto have taken all steps necessary to comply with Section 251(g) of the Delaware General Corporation Law, including without limitation, the following: (a) Certificate of Incorporation and By-Laws of Surviving Corporation. At the Effective Time, the certificate of incorporation and by-laws of Ccaps shall be and are in substantially identical form to the Certificate of Incorporation and Bylaws of CCVG, in each case as amended and in effect immediately prior to the Effective Time. 4 (b) Directors and Officers of Surviving Corporation. At the Effective Time, the directors and officers of CCVG immediately prior to the Effective Time shall be and are the directors and officers of Ccaps, in the case of directors, until their successors are elected and qualified and, in the case of officers, to serve at the pleasure of the Board of Directors of Ccaps. (c) Filings. At or prior to the Effective Time, the Surviving Corporation shall cause a copy of this Agreement to be executed and filed with the Secretary of State of the State of Delaware. At or prior to the Effective Time, to the extent necessary to effectuate any amendments to the certificates of incorporation of the Surviving Corporation and Hold Co. contemplated by this Agreement, each of the Surviving Corporation and Hold Co. shall cause to be filed with the Secretary of State of the State of Delaware such certificates or documents required to give effect hereto and thereto. 13. Termination. This Agreement may be terminated, and the Reorganization Merger and the other transactions provided for herein may be abandoned, at any time prior to the Effective Time, whether before or after approval of this Agreement by the Boards of Directors of Ccaps and CCVG, by action of the Board of Directors of CCVG if it determines for any reason, in its sole judgment and discretion, that the consummation of the Reorganization Merger would be inadvisable or not in the best interests of CCVG and its stockholders. 14. Counterparts. This Agreement may be executed in one or more counterparts, and each such counterpart hereof shall be deemed to be an original instrument, but all such counterparts together shall constitute but one agreement. 15. Descriptive Headings. The descriptive headings herein are inserted for convenience of reference only and are not intended to be part of or to affect the meaning or interpretation of this Agreement. 16. Governing Laws. This Agreement shall be governed by and construed in accordance with the laws of the State of Delaware. [Signatures to Follow on Next Page] 5 IN WITNESS WHEREOF, CCVG and Ccaps, as constituent companies, have caused this Agreement and Plan of Merger and Reorganization into Holding Company Structure to be executed and delivered as of the date first above written, and Hold Co. has joined this Agreement as the newly designated holding company for purposes of carrying out the intent of this Agreement. CCVG, INC., a Delaware corporation --------------------------------------- Name: David J. Cutler Title: President CCAPS CO., a Delaware corporation --------------------------------------- Name: David J. Cutler Title: President GOLDEN DRAGON HOLDING CO., a Delaware corporation --------------------------------------- Name: David J. Cutler Title: President 6 CERTIFICATE OF SECRETARY OF CCVG, INC. I hereby certify that the Agreement and Plan of Merger and Reorganization into Holding Company Structure has been adopted pursuant to Section 251(g) of Delaware General Corporation Laws Act as applicable and that the Resolutions of the Board of Directors authorizing the Agreement and Plan of Merger and Reorganization into Holding Company Structure have been duly adopted by the Boards of Directors as applicable. CCVG, Inc., a Delaware Corporation ---------------------------- Dated: _______________, 2010 Name: Title: Secretary 7 CERTIFICATE OF SECRETARY OF CCAPS CO. I hereby certify that the Agreement and Plan of Merger and Reorganization into Holding Company Structure has been adopted pursuant to Section 251(g) of Delaware General Corporation Laws Act as applicable and that the Resolutions of the Board of Directors authorizing the Agreement and Plan of Merger and Reorganization into Holding Company Structure have been duly adopted by the Boards of Directors as applicable. Ccaps Co., a Delaware Corporation ------------------- Dated: ________________, 2010 Name: Title: Secretary 8 EX-10.2 3 ex10-2.txt EXHIBIT 10.2 SHARE PURCHASE AGREEMENT THIS SHARE PURCHASE AGREEMENT (this "Agreement") dated as of December 31, 2010 by and between GOLDEN DRAGON HOLDING CO. ("Seller") and the Purchaser, James Clark ("Purchaser") 1. Purchase and Sale. Subject to the terms and conditions of this Agreement, Seller hereby sells to Purchaser 1,000 Shares of Common Stock of CCaps Co., and Purchaser hereby purchases from Seller such Shares of Common Stock (the "Purchased Securities"), for an aggregate purchase price of $100 payable upon delivery to Purchaser of a Share certificate registered in the name of Seller together with a duly executed stock power. 2. Representations and Warranties of Seller. Seller hereby represents and warrants to Purchaser that: a. Seller is duly authorized to enter into this Agreement and to perform their obligations hereunder. b. Seller has the right to dispose of the Purchased Securities to Purchaser without the consent of any other person or entity whatsoever, and upon delivery of the certificates representing the Purchased Securities to Purchaser, the Purchased Securities shall be owned by Purchaser free of any liens, charges, encumbrances, rights of first refusal or other adverse claims whatsoever. c. Concurrent with the Sale, Seller shall issue 25,000 shares of its common stock to CCaps Co. which CCaps Co. may use as capital. 3. Representations and Warranties of Purchaser. Purchaser hereby represents and warrants to Seller that: a. Purchaser is duly authorized to enter into this Agreement and to perform its obligations hereunder. b. Purchaser has made its own investigation of the business of the Issuer, and is not relying on any information about the Issuer and its business provided by Seller in making Purchaser's determination to purchase the Purchased Securities, and Purchaser understands that there is significant debt on the books of CCaps Co. c. Purchaser hereby represents that he/she will not resell the Shares in any transaction for which an exemption is not available without first registering the shares for resale. d. Purchaser hereby acknowledges that the Shares are "Restricted," will bear a restrictive legend, and further, a legend stating the securities are not registered with the Securities and Exchange Commission. e. Purchaser represents that he/she has received all currently available financial information for the Company for which the Shares are issued and have received any other information requested about the Company or its securities. f. Purchaser represents that either a) he/she is an "accredited investor" as defined in Regulation D, or b) he/she is a sophisticated investor having such knowledge and experience in investing and having received such information about the Company and its securities that he/she deems the investment appropriate and suitable for him or her. g. Purchaser represents he/she is purchasing the Shares for investment purposes only and not with a view to distribution to the public. h. Purchaser represents that no public solicitation of him/her was made. 4. Governing Law. This Agreement shall be governed by and construed in accordance with the internal laws of the State of Colorado with respect to agreements entered into within Colorado by residents thereof. 5. Counterparts, Facsimile Signatures. This Agreement may be executed in one or more counterparts, each of which shall be considered an original document. This Agreement may be delivered by facsimile, which shall be deemed an original counterpart for all purposes. Seller: GOLDEN DRAGON HOLDING CO. Purchaser: JAMES CLARK By: _____________________________ _____________________________ Name: David J. Cutler James Clark Title: CEO Address: SS #: ________________________ -----END PRIVACY-ENHANCED MESSAGE-----