Hart-Scott-Rodino (HSR) Form

Filing Information

This is a re-file of a previously submitted HSR form

*Filing As Acquiring Party
Acquired Party

Party Information

Acquiring Party Information

* Acquiring UPE Name:

*Address:

International Address?

*City:

*State:

*Postal Code:

Same as Acquiring UPE?

* Acquiring Entity Name:

*Address:

International Address?

*City:

*State:

*Postal Code:

Acquired Party Information

* Acquired UPE Name:

*Address:

International Address?

*City:

*State:

*Postal Code:

Same as Acquired UPE?

* Target Name:

*Address:

International Address?

*City:

*State:

*Postal Code:

Contact Information

Primary HSR Report Contact

*Primary HSR Report Contact

*Firm Name:

*Address:

International Address?

*City:

*State:

*Postal Code:

*Contact Phone:

*Contact Email:

Secondary HSR Report Contact

*Secondary HSR Report Contact

*Firm Name:

*Address:

International Address?

*City:

*State:

*Postal Code:

*Contact Phone:

*Contact Email:

Additional HSR Report Contact

Firm Name:

Address:

International Address?

City:

State:

Postal Code:

Contact Phone:

Contact Email:

Details

Transaction Description Transaction Type (check all that apply)

Acquisition of voting securities

Acquisition of non-corporate interests

Acquisition of assets

Merger (see § 801.2)

Consolidation (see § 801.2)

Acquisition subject to § 801.30 (specify type):

Formation of a joint venture, other corporation, or unincorporated entity (see § 801.40 or § 801.50)

Acquisition subject to § 801.31

Secondary acquisition subject to § 801.4

Acquisition subject to § 801.2(e)

Other (please specify):

Business of the Target

*Transaction Description

Proposed Closing Date of Transaction

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Additional Information Please add any additional information here

Documents

Please attach completed HSR form and any supplemental documents.

Maximum size of supplemental files is 2GB (files may be zipped).

*Upload HSR Form

Upload Supplemental Documents

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Acknowledgment

By selecting YES below, I certify the completeness and accuracy of this submission.

I certify that this information is accurate

*Signed Name

*Email

*Title or Position

*Company

Washington State

Attorney General

Filing Information

Party Information

Contact Information

Details

Acknowledgment

Attorney General

Hart-Scott-Rodino (HSR) Detail Form

Filing Information

Party Information

Contact Information

Details

Acknowledgment