Docstoc

Free Receipt Template

Document Sample
Free Receipt Template Powered By Docstoc
					Electronic Filing




To file your claim electronically, click the Excel Efile Template (above) for the proper format.


Instructions:

 1.   Click on the Excel Efile Template link above.
 2.   Save the file on your computer.
 3.   Open the file with Microsoft Excel and fill it in.
 4.   Additionally, please follow the instructions in the Notice Packet.

Important Notes:

           This format is used for Institutions, Brokers and Nominees only. This is not used for Individual potentia

           PDF files are not accepted for electronic filing. Only a completed Excel Efile Template worksheet will b

        Please fill out one "Master" or "Umbrella" Proof of Claim and Release entirely, and attach a list of accou
       filing on behalf. We do request that you either mail the electronic data (CD) with the Proof of Claim to the a
       emails) or upload it to our secured FTP site. Please submit documents showing you have authority to file o
       clients, and submit a statement that discloses the source of the data contained on the data file (i.e. where th
       extracted from such as a Broker's proprietary database).
**PLEASE NOTE - AS OF JUNE 20, 2006, THE TICKER CHANGED FROM XTHN (OTCBB) TO XNL (AMEX).


If you would like to mail the via courier, please use the address below.

In re Xethanol Corporation Securities Litigation Settlement
c/o Complete Claim Solutions, LLC
5210 Hood Road
Palm Beach Gardens, FL 33418

If you would like to upload your claim to a secured FTP site, please contact us at (877) 625-9442 and we will prov
per format.




 is not used for Individual potential claimants.

el Efile Template worksheet will be accepted.

 entirely, and attach a list of account names you are
D) with the Proof of Claim to the address provided (no
 owing you have authority to file on behalf of your
 ned on the data file (i.e. where the data was

BB) TO XNL (AMEX).




 (877) 625-9442 and we will provide that information to you.
                                             Zale Electronic Claim Format



     Column Heading                          Description

     Last Name Beneficial Owner
1    (Individual, Joint, or IRA accounts     Last name of Beneficial Owner - Individual or Joint Accounts only. If IRA and you want
     ONLY)                                   the check made out to IRA, use the following format: JONES IRA
2    First Name Beneficial Owner             First name of Beneficial Owner
3    Last Name of Co-Owner, if applicable
                                             Last Name of Co-Owner (if applicable)
4    First Name of Co-Owner, if applicable
                                             First name of Co-Owner
                                             Name of Company, Trust, Estate, etc. THIS COLUMN SHOULD NEVER BE
5    Entity Name                             POPULATED IF COLUMN 1 (Last Name Beneficial Owner - for Individual, Joint, or
                                             IRA accounts Only) IS POPULATED
                                             Representative Name, if applicable (e.g. executor, custodian, trustee, administrator,
6    Representative Name
                                             nominee,etc)
7    Addr1                                   Addr1
8    Addr2                                   Addr2
9    City                                    City
10   State                                   State
11   Zip5                                    Zip5
12   Zip4                                    Zip4
13   Account #                               Account Number
14   Tax Id #                                Acct holders Tax Id or SSN
15   CUSIP                                   Security Cusip
                                             B = Beginning Balance as of 01/31/2006
                                             P = Open Market Purchases from 1/31/2006 through 8/8/2006
                                             PR = Free Receipt Transfer into this account from 01/31/2006 through 08/08/2006
16 Type                                      P2= Total Number of Shares Purchased 08/09/2006 to 08/16/2006
                                             S = Open Market Sales from 01/31/2006 through 08/15/2006
                                             SD = Free Delivery Transfer to another account from 01/31/2006 through 08/15/2006
                                             U = Unsold Shares - Balance as of 08/16/2006 (one record per acct per security code)
                                             Common Stock = "XLN"
17 Security Code
                                             Cusip 98420A103
18 Trade Date                                Transaction Date
19 Shares                                    Qty of shares for Common Stock
20 Price/Share                               Price per share for Common Stock
                                             Total Amount Paid for Purchases; Total Amount Received for Sales; leave blank for all
21 Net Amount                                others



     Instructions:
>    Columns 1 thru 4 are for Individual, Joint, or IRA accounts only
>    Column 5 is for Entities (Corporations, Estates, Trusts, etc.) only
>    EITHER Column 1-4 OR Column 5 should be populated - NEVER all 5 Columns
>    Columns 7 through 19 are required for every transaction.
>    Only ONE Beginning Balance and ONE Unsold Shares transaction per Acct #
>    Please use mm/dd/yyyy format for all date fields
>    For fields 16 and 17 please use provided abbreviations
   Beneficial Owner Last Name                                                             Entity Name
(Individual, Joint, or IRA accounts   Beneficial Owner   Co-Owner Last   Co-Owner     (Corporation, Estate,   Rep name (e.g. Custodian,
                only)                   First Name           Name        First Name        Trust, etc.)        Trustee, Executor, etc.)   Addr1   Addr2   City   State   Zip5   Zip4   Account #
Tax Id # CUSIP Type Security Code Trade Date # of Shares Price/Share   Amt Pd or Rec'd.
   Beneficial
 Owner Last
     Name
  (Individual,
 Joint, or IRA    Beneficial                                 Entity Name              Rep name (e.g.
   accounts      Owner First   Co-Owner      Co-Owner       (Corporation,               Custodian,
     only)          Name       Last Name     First Name   Estate, Trust, etc.)    Trustee, Executor, etc.)
Smith            John
Smith            John
Smith            John
Smith            John
Smith            John

                                                          XYZ Corporations       Attn: John Doe, President
                                                          XYZ Corporations       Attn: John Doe, President
                                                          XYZ Corporations       Attn: John Doe, President

Simmons          Bob           Simmons     Betty
Simmons          Bob           Simmons     Betty

Jones IRA        Robert                                                          ABC Bank, Custodian
Jones IRA        Robert                                                          ABC Bank, Custodian
         Addr1               Addr2          City          State    Zip5       Zip4    Account #
123 Anywhere Street       America Plaza   Hometown   AL              12345       6789     12345
123 Anywhere Street       America Plaza   Hometown   AL              12345       6789     12345
124 Anywhere Street       America Plaza   Hometown   AL              12345       6789     12345
123 Anywhere Street       America Plaza   Hometown   AL              12345       6789     12345
123 Anywhere Street       America Plaza   Hometown   AL              12345       6789     12345

456 Overthere Road        Bldg 100        Big City   NY              98765      4321      44444
456 Overthere Road        Bldg 100        Big City   NY              98765      4321      44444
456 Overthere Road        Bldg 100        Big City   NY              98765      4321      44444

15678 Nowhere Boulevard                   Downtown TN                65432                78945
15678 Nowhere Boulevard                   Downtown TN                65432                78945

538 Everywhere                            Uptown     FL           000045678     4561      45678
539 Everywhere                            Uptown     FL           000045678     4561      45678
Tax Id #      CUSIP        Type    Security Code   Trade Date
 123456789   98420A103   B        XNL                           1/31/2006
 123456789   98420A103   P        XNL                           3/15/2006
 123456789   98420A103   P2       XNL                           8/10/2006
 123456789   98420A103   S        XNL                           5/25/2006
 123456789   98420A103   U        XNL                           8/16/2006

987654321 98420A103 B             XNL                           1/31/2006
987654321 98420A103 P             XNL                           4/29/2006
987654321 98420A103 U             XNL                           8/16/2006

012345678 98420A103 P             XNL                           5/16/2006
012345678 98420A103 U             XNL                           8/16/2006

789456123 98420A103 P             XNL                            6/6/2006
789456123 98420A103 S             XNL                           7/25/2006
# of Shares          Price/Share        Amt Pd or Rec'd.
              1000
              1500                 50             75312.5
               600
               500                 50            24856.22
              2600

                1
                1                  90                 950
                2

               10              92.5              93187.25
               10

              100                  50                5156
              100                  25                2345

				
DOCUMENT INFO
Description: Free Receipt Template document sample