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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 | ||||||||
Convertible Promissory Note | $ 1.25 | 01/11/2006 | P | 350,000 | (1) | (2) | Series E Preferred Stock | (3) | $ 0 | 350,000 | D | ||||
Convertible Promissory Note | $ 1.25 | 01/11/2006 | P | 350,000 | (1) | (2) | Warrants to acquire Common Stock (right to buy) | (3) | $ 0 | 350,000 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Howitt David Marc 2836 SW PERIANDER STREET PORTLAND, OR 97201 |
X |
Ernest C Mysogland as Attorney-in-fact | 01/19/2006 | |
**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) | Automatic conversion will occur upon the effectiveness of the filing of the Certificate of Designations, Preferences and Rights pertaining to the Company's Series E Preferred Stock. |
(2) | If the Certificate of Designations, Preferences and Rights pertaining to the Company's Series E Preferred Stock is not filed by February 10, 2006, the holders may demand that the Company repay the principal amount of the Note plus accrued interest. |
(3) | The Convertible Promissory Note is automatically convertible into (i) such number of fully paid and non-assessable shares of the Company's Series E Preferred Stock equal to the aggregate outstanding principal amount due under the Notes plus the amount of all accrued but unpaid interest under the Notes divided by $1.25, and (ii) warrants to purchase a number of shares of the Company's Common Stock equal to 40% of such number of shares of Series E Stock issued to the holder. The exact number of shares and warrants into which the Note is convertible cannot be determined at this time because the amount of interest that will accrue prior to the date of conversion is not known. |