# EDGAR Filing Document

**Accession Number:** 0001816586
**File Stem:** 0001193125-25-236706
**Filing Date:** 2025-10
**Character Count:** 19410
**Document Hash:** fa8f180797c2c9791dc9a8d6a8433b94
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001193125-25-236706.hdr.sgml**: 20251010

**ACCESSION NUMBER**: 0001193125-25-236706

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20251008

**FILED AS OF DATE**: 20251010

**DATE AS OF CHANGE**: 20251010

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Ignition Acquisition Holdings LP
- **CENTRAL INDEX KEY:** 0001816556

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-34568
- **FILM NUMBER:** 251386979

**BUSINESS ADDRESS:**
- **STREET 1:** C/O APAX PARTNERS US LLC
- **STREET 2:** 601 LEXINGTON AVENUE, 58TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10017
- **BUSINESS PHONE:** 212-753-6300

**MAIL ADDRESS:**
- **STREET 1:** C/O APAX PARTNERS US LLC
- **STREET 2:** 601 LEXINGTON AVENUE, 58TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10017
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Apax Guernsey (Holdco) PCC Ltd
- **CENTRAL INDEX KEY:** 0001469807

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** X0

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-34568
- **FILM NUMBER:** 251386973

**BUSINESS ADDRESS:**
- **ADDRESS IS A NON US LOCATION:** YES
- **STREET 1:** THIRD FLOOR, ROYAL BANK PLACE
- **STREET 2:** 1 GLATEGNY ESPLANADE
- **CITY:** ST. PETER PORT
- **PROVINCE COUNTRY:** Y7
- **BUSINESS PHONE:** 44 01481 810 000

**MAIL ADDRESS:**
- **ADDRESS IS A NON US LOCATION:** YES
- **STREET 1:** THIRD FLOOR, ROYAL BANK PLACE
- **STREET 2:** 1 GLATEGNY ESPLANADE
- **CITY:** ST. PETER PORT
- **PROVINCE COUNTRY:** Y7

**FORMER NAME:**
- **FORMER CONFORMED NAME:** Apax Guernsey (Holdco) Ltd
- **DATE OF NAME CHANGE:** 20090806
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Ignition Acquisition Holdings GP LLC
- **CENTRAL INDEX KEY:** 0001816546

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-34568
- **FILM NUMBER:** 251386978

**BUSINESS ADDRESS:**
- **STREET 1:** C/O APAX PARTNERS US LLC
- **STREET 2:** 601 LEXINGTON AVENUE, 58TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
- **BUSINESS PHONE:** 212-753-6300

**MAIL ADDRESS:**
- **STREET 1:** C/O APAX PARTNERS US LLC
- **STREET 2:** 601 LEXINGTON AVENUE, 58TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Ignition Topco Ltd
- **CENTRAL INDEX KEY:** 0001817060

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** Y7
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-34568
- **FILM NUMBER:** 251386975

**BUSINESS ADDRESS:**
- **STREET 1:** P.O. BOX 656, EAST WING
- **STREET 2:** TRAFALGAR COURT
- **CITY:** ST. PETER PORT
- **STATE:** Y7
- **ZIP:** GY1 3PP
- **BUSINESS PHONE:** 212-753-6300

**MAIL ADDRESS:**
- **STREET 1:** P.O. BOX 656, EAST WING
- **STREET 2:** TRAFALGAR COURT
- **CITY:** ST. PETER PORT
- **STATE:** Y7
- **ZIP:** GY1 3PP
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Ignition GP LLC
- **CENTRAL INDEX KEY:** 0001816586

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-34568
- **FILM NUMBER:** 251386976

**BUSINESS ADDRESS:**
- **STREET 1:** C/O APAX PARTNERS US LLC
- **STREET 2:** 601 LEXINGTON AVENUE, 58TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
- **BUSINESS PHONE:** 212-753-6300

**MAIL ADDRESS:**
- **STREET 1:** C/O APAX PARTNERS US LLC
- **STREET 2:** 601 LEXINGTON AVENUE, 58TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Ignition Parent LP
- **CENTRAL INDEX KEY:** 0001816602

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-34568
- **FILM NUMBER:** 251386977

**BUSINESS ADDRESS:**
- **STREET 1:** C/O APAX PARTNERS US LLC
- **STREET 2:** 601 LEXINGTON AVENUE, 58TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
- **BUSINESS PHONE:** 212-753-6300

**MAIL ADDRESS:**
- **STREET 1:** C/O APAX PARTNERS US LLC
- **STREET 2:** 601 LEXINGTON AVENUE, 58TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Apax X GP Co. Ltd
- **CENTRAL INDEX KEY:** 0001817053

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** Y7
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-34568
- **FILM NUMBER:** 251386974

**BUSINESS ADDRESS:**
- **ADDRESS IS A NON US LOCATION:** YES
- **STREET 1:** THIRD FLOOR, ROYAL BANK PLACE
- **STREET 2:** 1 GLATEGNY ESPLANADE
- **CITY:** ST. PETER PORT
- **PROVINCE COUNTRY:** Y7
- **BUSINESS PHONE:** 212-753-6300

**MAIL ADDRESS:**
- **ADDRESS IS A NON US LOCATION:** YES
- **STREET 1:** THIRD FLOOR, ROYAL BANK PLACE
- **STREET 2:** 1 GLATEGNY ESPLANADE
- **CITY:** ST. PETER PORT
- **PROVINCE COUNTRY:** Y7
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** OPENLANE, Inc.
- **CENTRAL INDEX KEY:** 0001395942
- **STANDARD INDUSTRIAL CLASSIFICATION:** RETAIL-AUTO DEALERS & GASOLINE STATIONS [5500]
- **ORGANIZATION NAME:** 07 Trade & Services
- **EIN:** 208744739
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 11299 N. ILLINOIS STREET
- **CITY:** CARMEL
- **STATE:** IN
- **ZIP:** 46032
- **BUSINESS PHONE:** (800) 923-3725

**MAIL ADDRESS:**
- **STREET 1:** 11299 N. ILLINOIS STREET
- **CITY:** CARMEL
- **STATE:** IN
- **ZIP:** 46032

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** KAR Auction Services, Inc.
- **DATE OF NAME CHANGE:** 20091103

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** KAR Holdings, Inc.
- **DATE OF NAME CHANGE:** 20070409

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Ignition Acquisition Holdings LP<br><sub>(Last) (First) (Middle)</sub><br>C/O APAX PARTNERS US LLC<br>601 LEXINGTON AVENUE, 58TH FLOOR<br><sub>(Street)</sub><br>NEW YORK, NY 10022<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-10-08 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>OPENLANE, Inc. [ KAR ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Ignition Acquisition Holdings GP LLC<br><sub>(Last) (First) (Middle)</sub><br>C/O APAX PARTNERS US LLC<br>601 LEXINGTON AVENUE, 58TH FLOOR<br><sub>(Street)</sub><br>NEW YORK, NY 10022<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-10-08 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>OPENLANE, Inc. [ KAR ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Ignition Parent LP<br><sub>(Last) (First) (Middle)</sub><br>C/O APAX PARTNERS US LLC<br>601 LEXINGTON AVENUE, 58TH FLOOR<br><sub>(Street)</sub><br>NEW YORK, NY 10022<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-10-08 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>OPENLANE, Inc. [ KAR ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Ignition GP LLC<br><sub>(Last) (First) (Middle)</sub><br>C/O APAX PARTNERS US LLC<br>601 LEXINGTON AVENUE, 58TH FLOOR<br><sub>(Street)</sub><br>NEW YORK, NY 10022<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-10-08 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>OPENLANE, Inc. [ KAR ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Ignition Topco Ltd<br><sub>(Last) (First) (Middle)</sub><br>P.O. BOX 656, EAST WING, TRAFALGAR COURT<br><sub>(Street)</sub><br>LES BANQUES, ST. PETER PORT, Y7 GY1 3PP<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-10-08 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>OPENLANE, Inc. [ KAR ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Apax X GP Co. Ltd<br><sub>(Last) (First) (Middle)</sub><br>THIRD FLOOR, ROYAL BANK PLACE,<br>1 GLATEGNY ESPLANADE<br><sub>(Street)</sub><br>ST. PETER PORT, Y7 GY1 2HJ<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-10-08 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>OPENLANE, Inc. [ KAR ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Apax Guernsey (Holdco) PCC Ltd<br><sub>(Last) (First) (Middle)</sub><br>THIRD FLOOR, ROYAL BANK PLACE,<br>1 GLATEGNY ESPLANADE<br><sub>(Street)</sub><br>ST. PETER PORT, Y7 GY1 2HJ<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-10-08 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>OPENLANE, Inc. [ KAR ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
|  |  |  |  |  |  |  |  |  |  |  |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Series A Preferred Stock | <sup>(1)</sup> | 2025-10-08 |  | S<sup>(2)</sup> |  |  | 288322 | <sup>(1)</sup> | <sup>(1)</sup> | Common Stock | 16243485 | <sup>(1)</sup> | 288323<sup>(3)</sup> | I | See Footnotes<sup>(4)(5)</sup> |

---

### Footnotes:

(1) Reflects Series A Preferred Stock, par value $0.01 per share, of the Issuer ("Series A Preferred Stock"). The Series A Preferred Stock has no stated maturity, and beginning on June 10, 2021, the Series A Preferred Stock were convertible at the option of the holders thereof into shares of common stock, par value $0.01 per share, of the Issuer ("Common Stock") at an initial conversion price of $17.75 per share of Series A Preferred Stock and an initial conversion rate of 56.3380 shares of Common Stock per share of Series A Preferred Stock, subject to adjustment as provided in the Certificate of Designations of the Series A Preferred Stock ("Certificate of Designations"). The Issuer may mandatorily convert the Series A Preferred Stock into Common Stock at any time after the three-year anniversary of the issuance, if certain conditions are met.

(2) Reflects a repurchase by the Issuer of 288,322 shares of Series A Preferred Stock from the Reporting Persons for aggregate consideration of $482,431,500.

(3) The amount reported as beneficially owned includes Series A Preferred Stock received as dividends but excludes accrued dividends not yet declared by the Issuer pursuant to the terms of the Certificate of Designations.

(4) Reflects securities held directly by Ignition Acquisition Holdings LP. Ignition Acquisition Holdings GP LLC is the general partner of Ignition Acquisition Holdings LP. Ignition Parent LP is the sole member of Ignition Acquisition Holdings GP LLC. Ignition GP LLC is the general partner of Ignition Parent LP. Ignition Topco Ltd is the sole member of Ignition GP LLC. Apax X GP Co. Limited, in its capacity as investment manager of the Apax funds, controls 100% of the shares of Ignition Topco Ltd. Apax Guernsey (Holdco) PCC Limited Apax X Cell is the sole parent of Apax X GP Co. Limited.

(5) Each of the Reporting Persons may be deemed to beneficially own the securities beneficially owned by Ignition Acquisition Holdings LP directly or indirectly controlled by it, but each (other than Ignition Acquisition Holdings LP to the extent of its direct holdings) disclaims beneficial ownership of such shares, except to the extent of such Reporting Person's pecuniary interest therein. The filing of this statement shall not be deemed to be an admission that, for purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise, the Reporting Persons are the beneficial owners of any securities reported herein.

**Signature:** IGNITION ACQUISITION HOLDINGS LP, By: Ignition Acquisition Holdings GP LLC, its general partner, By: /s/ Steven Kooyers, Name: Steven Kooyers, Title: Treasurer and Secretary  
**Date:** 2025-10-10

**Signature:** IGNITION ACQUISITION HOLDINGS GP LLC, By: /s/ Steven Kooyers, Name: Steven Kooyers, Title: Treasurer and Secretary  
**Date:** 2025-10-10

**Signature:** IGNITION PARENT LP, By: Ignition GP LLC, its general partner, By: /s/ Steven Kooyers, Name: Steven Kooyers, Title: Treasurer and Secretary  
**Date:** 2025-10-10

**Signature:** IGNITION GP LLC, By: /s/ Steven Kooyers, Name: Steven Kooyers, Title: Treasurer and Secretary  
**Date:** 2025-10-10

**Signature:** IGNITION TOPCO LTD, By: /s/ Mark Babbe, Name: Mark Babbe, Title: Director  
**Date:** 2025-10-10

**Signature:** APAX X GP CO. LIMITED, By: /s/ Jeremy Latham, Name: Jeremy Latham, Title: Director  
**Date:** 2025-10-10

**Signature:** APAX GUERNSEY (HOLDCO) PCC LIMITED ACTING IN RESPECT OF ITS APAX X CELL, By: /s/ Simon March, Name: Simon March, Title: Authorised Signatory for and on behalf of Apax Partners Guernsey Limited as Company Secretary to Apax Guernsey (Holdco) PCC Limited  
**Date:** 2025-10-10

### Remarks:

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.

* 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).

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.

**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 Number.**