-----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, WqNRjm/vh5jkearxOEvV1OQJcxo1bz21W2gXa7VqATlUN8wk5GZe6kwGUZQdsEUd c+FIz5UrIisMt0Mvrmd/lA== 0001121781-04-000305.txt : 20041117 0001121781-04-000305.hdr.sgml : 20041117 20041117165022 ACCESSION NUMBER: 0001121781-04-000305 CONFORMED SUBMISSION TYPE: SC 13D PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20041117 DATE AS OF CHANGE: 20041117 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: GOTTLIEB JAY CENTRAL INDEX KEY: 0001218021 FILING VALUES: FORM TYPE: SC 13D MAIL ADDRESS: STREET 1: 27 MISTY BROOK LANE CITY: NEW FAIRFIELD STATE: CT ZIP: 06812 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: XTRANA INC CENTRAL INDEX KEY: 0000830736 STANDARD INDUSTRIAL CLASSIFICATION: IN VITRO & IN VIVO DIAGNOSTIC SUBSTANCES [2835] IRS NUMBER: 581729436 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13D SEC ACT: 1934 Act SEC FILE NUMBER: 005-40396 FILM NUMBER: 041152659 BUSINESS ADDRESS: STREET 1: PO BOX 668 CITY: SEDALIA STATE: CO ZIP: 80135 BUSINESS PHONE: 3034664424 MAIL ADDRESS: STREET 1: PO BOX 668 CITY: SEDALIA STATE: CO ZIP: 80135 FORMER COMPANY: FORMER CONFORMED NAME: BIOPOOL INTERNATIONAL INC DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: CYTRX BIOPOOL LTD DATE OF NAME CHANGE: 19890716 SC 13D 1 gottliebsc13dxtrana111604.txt JAY GOTTLIEB 11/17/04 SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13D The Securities Exchange Act of 1934 Xtrana, Inc. (Name of Issuer) Common Stock (Title Class of Securities) 98415F 10 9 (CUSIP Number) CARL N. DUNCAN, ESQ. 5718 TANGLEWOOD DRIVE BETHESDA, MARYLAND 20817 (301) 263-0200 (Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications) November 8, 2004 (Date of Event Which Requires Filing of This Statement) - ------------------------------------------------------------------ -------------------------------------------- (1) Name of Reporting Person / I.R.S. Identification Number Jay Gottlieb - ------------------------------------------------------------------ -------------------------------------------- (2) Check the appropriate box if may be deemed member of a group (a) N/A -------------------------------------------- (b) Reporting Person disclaims being member of a group relating to Issuer - ------------------------------------------------------------------ -------------------------------------------- (3) SEC use only ............................................... - ------------------------------------------------------------------ -------------------------------------------- (4) Source of funds (see instructions).......................... PF - ------------------------------------------------------------------ -------------------------------------------- (5) Check if disclosure of legal proceedings is required pursuant to Items 2(d)or 2(e). N/A - ------------------------------------------------------------------ -------------------------------------------- (6) Citizenship or place of organization........................ USA/incorporation inapplicable since the Reporting Person is an individual - ------------------------------------------------------------------ -------------------------------------------- Number of shares beneficially owned by Reporting Person with: (7) Sole voting power .......................................... 1,053,000 (See Item 4) (8) Shared voting power......................................... 0 (9) Sole dispositive power ................................... 1,053,000 (See Item 4) (10) Shared dispositive power ................................... 0 - ------------------------------------------------------------------ -------------------------------------------- (11) Aggregate amount beneficially owned by Reporting Person 1,053,000 (See Item 4) - ------------------------------------------------------------------ -------------------------------------------- (12) Check if the aggregate amount in Row (11) excludes certain shares (see instructions). N/A - ------------------------------------------------------------------ -------------------------------------------- (13) Percent of class represented by amount in Row (11) ......... 6.37% (See Item 5) - ------------------------------------------------------------------ -------------------------------------------- (14) Type of reporting person (see instructions)................. IN - ------------------------------------------------------------------ --------------------------------------------
ITEM 1. SECURITY AND ISSUER. - ---------------------------- (a) Title of Class: Common Stock (b) Name and Address of Issuer: Xtrana Corp. P.O. Box 668 Sedalia, Colorado 80135 (c) Trading Symbol: XTRN ITEM 2. IDENTITY AND BACKGROUND OF THE REPORTING ENTITY. - -------------------------------------------------------- (a) Name: Jay Gottlieb (b) Business Address 27 Misty Brook Lane New Fairfield, Connecticut 06812 (c) Occupation: Private Investor (d) Conviction: N/A (e) Civil Proceedings: N/A (f) State of Incorporation: N/A since Reporting Person is an individual ITEM 3. SOURCE AND AMOUNT OF FUNDS OR OTHER CONSIDERATION. - ---------------------------------------------------------- The Reporting Person has used personal funds to acquire his 1,053,000 Common Shares of the Issuer. ITEM 4. PURPOSE OF TRANSACTION. - -------------------------------- Reporting Person is making these purchases of Issuer's Common Shares for investment purposes only. There is no intent to gain control of the Issuer and Reporting Person is not a member of a group relating to the Issuer. Other than as described in this Schedule 13D, the Reporting Person is not aware of any plans or proposals which would result in the acquisition by any person of additional securities of Issuer or the disposition of securities of the Issuer; any extraordinary corporate transaction, such as a merger, reorganization or liquidation, involving the Issuer or any of its subsidiaries; a sale or transfer of a material amount of assets of the Issuer or any of its subsidiaries; any change in the present board of directors or management of the Issuer, including any place or proposals to change the number or term of directors or to fill any existing vacancies on the Issuer's Board; any material change in the present capitalization or dividend policy of the Issuer; any other material change in the Issuer's business or corporate structure; any changes in Issuer's charter, bylaws or instruments corresponding thereto or other actions which may impede the acquisition of control of the Issuer by any person; causing a class of securities of the Issuer to be delisted from national securities exchange or to cease to be authorized to be quoted in an inter-dealer quotation system of a registered national securities association; a class of equity securities of the Issuer becoming eligible for termination of registration pursuant to section 12(g)(4) of the Act; or any action similar to any of those enumerated above. ITEM 5. INTEREST IN SECURITIES OF THE ISSUER. - --------------------------------------------- (a) Aggregate Number and %: 1,0053,000 Common Shares on a fully diluted basis- - i.e., 6.37% of the total 16,533,269 outstanding Common Shares of the Issuer. (b) Power to Vote or Dispose of Issuer's Shares: 1,0053,000 Common Shares on a fully diluted basis, power over which to vote or dispose of resides with the Reporting Person. (c) Transactions Within Prior 60 Days: No transactions have been effected between the Issuer and the Reporting Person beyond those described in Item 4 specifically and this Schedule 13D generally. Information contained in Item 4 above is hereby incorporated by reference. ITEM 6. CONTRACTS, ARRANGEMENTS, UNDERSTANDING OR RELATIONSHIPS WITH RESPECT - ----------------------------------------------------------------------------- TO SECURITIES OF THE ISSUER. - ---------------------------- Other than the foregoing, there are no contracts, arrangements, understandings or relationships not described herein. ITEM 7. MATERIAL TO BE FILED AS EXHIBITS. - ----------------------------------------- None SIGNATURE After reasonable inquiry and to the best of my knowledge and belief, the undersigned certifies he is Jay Gottlieb, the Reporting Person, and that the information set forth in this Schedule 13D is true, complete and correct. Dated: November 17, 2004 /s/ Jay Gottlieb ---------------- Jay Gottlieb -----END PRIVACY-ENHANCED MESSAGE-----