N.Y. Form M-11 ** File No.
(Rev. 4/89) (for renewals only)
STATE OF NEW YORK
DEPARTMENT OF LAW
ISSUER STATEMENT
(Section 359a Gen. Bus. Law)
Name of Issuer Street Address City State Zip
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ICON ACQUISITION CORP. 2541 Monroe Ave. Suite 301, Rochester, NY 14618
Telephone Number 716-244 -1840
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This form is not to be used by issuers engaged in any aspect of real estate or
mortgage financing unless they also obtain a letter upon written application
pursuant to Section 352e or g. Theatrical Syndication must comply with Article
26-A of the General Business Law.
1. Issuer is [x] an existing; [ ] a proposed; [x] corporation; [ ] general
partnership; [ ] limited partnership; [ ] other (specify) _________________
organized under the laws of New York on 11/28/94.The entire offering is [ ]
intrastate, [x] interstate
2. The business of the issuer is (described briefly) TUNGSTEN MINING
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3. Issuer proposes to offer [x] stock; [ ] bonds; [ ] notes; [ ] partnership
interests; [ ] other (specify)_______________________
4. The securities will be sold [x] by the officers and directors of the
issuer; [ ] N.Y. registered broker [ ) by an underwriter; [ ] by salesmen
employed by issuer. The securities will be sold on a [x] best efforts
basis; [ ] firm commitment. If by an underwriter or broker, indicate the
names of underwriters or syndicate manager______________________
5. Total amount of offering $ 8,573.34 Anticipated offering expenses total
$ none consisting of: Selling:$ None Other: $ Organizational expense
$ 8,200.00 Working capital $ 373.37
6. State use of the net proceeds to be obtained _________________
Organizational expense and woking capital
** Found on the fee receipt you received for your orginal filing.
Filing is incomplete without a copy Filing Fee Enclosed as Follows:
of offering literature. If not Total amount of offering
available, please explain. under $500,000 ..........$200
Indicate to whom you wish over $500,000 ...........$800
the fee receipt sent.
( ) Attorney (x) Issuer Send remittance to:
Bureau of Investor Protection
Personal checks not accepted. and Securities
Attorney's check, certified check, N.Y. Department of law
bank check, money order only, 120 Broadway
payable to the N.Y.S. Department New York, NY 10 271
of Law
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7. If the securities are being offered partly or entirely for the account of
selling holders please check [ ]. Indicate the details of the secondary
offering below for each seller.
Anticipated
Name of Seller Address Dollar Amount Offered
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N/A
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8 Has registrant, any officer, director or principal or partner ever
A. been suspended or expelled from membership in any securities or
commodities exchange, association of securities or commodities
dealers or investment advisors? ................................Yes [ ] No [x]
B. had a license or registration as a dealer, broker, investment
advisor or salesman, futures commission merchant, associated
person, commodity pool operator, or commodity trading advisor
denied, suspended or revoked? ..................................Yes [ ] No [x]
C. been enjoined or restrained by any court or government agency
from:
1. the issuance, sale or offer for sale of securities or
commodities? ................................................Yes [ ] No [x]
2. rendering securities or commodities advice? .................Yes [ ] No [x]
3. handling or managing trading accounts? ......................Yes [ ] No [x]
4. continuing any practices in connection with securities or
commodities? ................................................Yes [ ] No [x]
D. been convicted of any crime(other than minor traffic)?.......Yes [ ] No [x]
E. used or been known by any other name? .......................Yes [ ] No [x]
F. been the subject of any professional disciplinary proceeding?Yes [ ] No [x]
G. been adjudged a bankrupt or made a general assignment for
benefit of creditors; or been an officer, director or principal of any
entity which was reorganized in bankruptcy, adjudged a bankrupt
or made a general assignment for benefit of creditors? .........Yes [ ] No [x]
H. had an offering of securities within the last three years or been an
officer, director, principal or partner of any entity which had an
offering of securities within the last three years .............Yes [ ] No [x]
I. If the answer to any of the above is "YES", attach a statement of full
particulars.
9. Are there any outstanding judgments (not including judgments involving
domestic relations) against the issuer or any officer, director, principal
or partner thereof? If yes, attach statement of full particulars
............................................................Yes [ ] No [x]
10. List names and residence addresses of all employees (officers and directors
not Included) of Issuer who are selling in N.Y.S., N.Y. Form M-2 must be
filed for each person listed.
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NONE
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11. Limited Partnerships are required to submit a list of all limited partners
as soon as the offering Is completed. This may be done in letter form.
12. If the Issuer is a limited partnership list all of the general partners:
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NOT A PARTNERSHIP
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<PAGE>
13. The information set forth below should be provided for each officer,
director, principal or partner. In the case of a corporate general partner
information must be provided for all officers. If not enough space is
provided use continuation sheets. Do not refer to prospectus or offering
literature. SEC biographies can be substituted for employment history only.
a. Name: Morris Diamond Title: President
Home Address: 105 Southern Parkway Phone: 716-244-1840
Place of Birth: Rochester, N.Y Date of Birth: 7/11/70
Social Security #: ###-##-#### Prior home addresses for past five years:
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Same as above
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Following is my complete employment and business affiliation record for
the past five years: (Indicate periods of self-employment and
unemployment. Include all corporations or other entities where you hold
or held a substantial equity or controlling interest.)
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From To Employer or Business Affiliation Position Held and
Mo. Yr. Mo. Yr. Name Address Type of Business
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Jan 80 Dec 95 105 Southern Parkway
Self Employed Rochester N.Y. 14618 Business Counseling
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b. Name: Shirley Diamond Title Secretary
Home Address: 105 Southern Parkway Phone: 716-473-6718
Place of Birth: Rochester, N.Y. Date of Birth:6/17/?3
Social Security ####-##-#### Prior home addresses for past five years:
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Same as above.
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Following is my complete employment and business affiliation record for the
past five years: (Indicate periods of self-employment and unemployment.
Include all corporations or other entities where you hold or held a
substantial equity or controlling interest.)
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From To Employer or Business Affiliation Position Held and
Mo. Yr. Mo. Yr. Name Address Type of Business
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Jul 84 Dec 95 Tramdot 105 Southern Parkway Investments
Development Corp.Rochester, NY President
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c. Name:Suzanne Luxenberg Title Asst Secretary
Home Address: 20 Castlebar Rd Roch N.Y. Phone: 716-442-3678
Place of Birth Rochester N.Y. Date of Birth 6/17/47
Social Security ###-##-#### Prior home addresses for past five years:
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Same as above
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Following is my complete employment and business affiliation record for the
past five years: (Indicate periods FseTFemployment and unemployment. Include
all corporations or other entities where you hold or held a substantial
equity or con(; oiling interest.)
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From To Employer or Business Affiliation Position Held and
Mo. Yr. Mo. Yr. Name Address Type of
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Jan 89 to date 2541 Monroe Ave. Rm 305 Roch. NY President
MS Acquisition Corp. House Builder
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The use of power of attorney is not acceptable. If all signatures are not
available at time of filing, you must submit the proper total fee and all
information required by Item 13. Note in your letter of transmittal that
counterpart forms with missing signatures will be submitted within 30 days of
filing.
Limited Partnerships must supply one signature for each general partner. One
signature by an officer of a corporate general partner is sufficient, however
all selling officers must sign.
Each of the undersigned, constituting all officers, directors, partners, and
controlling principals of the registrant do hereby state and represent that all
statements contained herein are true and correct and understands that any false
statement shall constitute a violation of Art. 23-A of the General Business Law.
Signature Name and Title (please type or print) Date
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/s/Morris Diamond Morris Diamond; President 10-1-96
/s/Shirley Diamond Shirley Diamond; Secretary 10-1-96
/s/Suzanne Luxenberg Suzanne Luxenberg; Asst. Secretary 10-1-96
To complete this filing a State Notice and Further State Notice must be filed
with the Secretary of State in Albany In the case of a non-resident issuer a
Consent to Service of Process must be filed with the Secretary of State.
All changes or amendments to this form must be submitted on NY Form M-3 with a
$20 fee.
<PAGE>
NYS DEPARTMENT OF STATE GAIL S. SHAFFER
MISCELLANEOUS RECORDS BUREAU Secretary of State
162 Washington Avenue
Albany, NY 12231-0001
A fee of $75 must accompany EACH State Notice and EACH Further State Notice.
This form constitutes two distinct notices and must be filed in DUPLICATE.
All remittances must be by cash, certified check, attorney's check, postal
money order or bank draft, payable to Department of State. Exception:
Attorney's checks will be accepted only for amounts up to and including
$250. Mail completed form and fee to the Miscellaneous Records Bureau at the
above address.
DO NOT SEND OFFERING LITERATURE to the Secretary of State.
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State Notice Under $ 359-e, subd. 2 the General Business Law of the State of New
York.
(this notice to be tiled by every security broker or dealer prior to engaging In
the business of selling or offering for sale securities to the public in the
State of New York.)
Name of Dealer' ICON ACQUISITION CORP.
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or
Broker'
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Business Address 2541 Monroe Ave. Suite 301, Rochester, New York 14618
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or
Post Office Address
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It a Corporation, the State or Country in which Incorporated NY
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If a Partnership, the Names of the General Partners
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Further State Notice Under ss.359-e, subd. 8 0l the General Business Law of the
State o1 New York (This notice to be filed for each Issue to be offered, except
those specifically exempted by $ 358-f.)
Name of Dealer' ICON ACQUISITION CORP.
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or
Broker'
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or
Syndicate Manager'
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Business Address 2541 Monroe Ave Suite 301, Rochester, New York 14618
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or
Post Office Address
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IF a Corporation, the State or Country in which Incorporated NY
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Name of Security or Securites (Class) Common
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Name of Issuer of Securities ICON AQUISITION CORP.
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Post Office Address or lssuer of Securities 2541 Monroe Ave. Suite 301,
Rochester, NY 14618
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The State or Country in which Organized NEW YORK
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A dealer is an issuer that is offering its own securities for sale.
A broker is any other person or firm offering the issuer's securities for sale.
A syndicate manager is a broker who is managing other brokers, all of whom are
offering the issuer's securities for sale.
