EXEMPT OFFERING PART 2
Dr. Henri Duvalier
504
REGULATION D
FORM D
FORM D
Notice of Exempt
Securities and Exchange Commission
Washington, DC 20549
OMB APPROVAL
OMB Number: 3235-0076
Expires: May 31, 2024 Estimated average burden hours per response: 5.00
Offering of Securities (See instructions beginning on page 5)
Intentional misstatements or omissions of fact constitute federal criminal violations. See 18 U.S.C. 1001.
Item 1. Issuer's Identity
Name of Issuer
Jurisdiction of Incorporation/Organization
Year of Incorporation/Organization
Entity Type (Select one) Corporation
FORM D
Limited Partnership
Yet to Be Formed
Previous Name(s) None
Limited Liability Company General Partnership
Business Trust
(Select one) Other (Specify)
Over Five Years Ago Within Last Five Years
(specify year)
(If more than one issuer is filing this notice, check this box and identify additional issuer(s) by attaching Items 1 and 2 Continuation Page(s).)
Item 2. Principal Place of Business and Contact Information
FORM D
Street Address 1 Street Address 2
City | State/Province/Country | ZIP/Postal Code | Phone No. | |||||
Item 3. Related Persons Last Name | First Name | Middle Name |
Street Address 1 Street Address 2
City State/Province/Country ZIP/Postal Code
Relationship(s):
Executive Officer
Director
Promoter
Clarification of Response (if necessary)
(Identify additional related persons by checking this box and attaching Item 3 Continuation Page(s). )
FORM D
Item 4. Industry Group (Select one)
Agriculture
Banking and Financial Services
Commercial Banking Insurance
Investing Investment Banking
Pooled Investment Fund
If selecting this industry group, also select one fund type below and answer the question below:
Hedge Fund Private Equity Fund
Venture Capital Fund Other Investment Fund
FORM D
Is the issuer registered as an investment company under the Investment Company Act of 1940? Yes No
Other Banking & Financial Services
Business Services Energy
Electric Utilities Energy Conservation Coal Mining
Environmental Services Oil & Gas
Other Energy
Health Care
Biotechnology
