Form 1-Z Issuer Information | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 1-Z EXIT REPORT UNDER REGULATION A | OMB APPROVAL |
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1-Z: Filer Information
Issuer CIK | 0001831191 |
Issuer CCC | XXXXXXXX |
File Number | |
Is this filing by a successor company pursuant to Rule 257(b)(5) resulting from a merger or other business combination? | ![]() ![]() |
Successor File Number |
Is this a LIVE or TEST Filing? | ![]() ![]() |
Is this an electronic copy of an official filing submitted in paper format? | ![]() |
Would you like a Return Copy? | ![]() |
Submission Contact Information
Name | |
Phone | |
E-Mail Address |
Notify via Filing Website only? | ![]() |
1-Z: PRELIMINARY INFORMATION
Exact name of issuer as specified in the issuer's charter | Revival AI Inc. |
Address of Principal Executive Offices | |
Address 1 | 10940 S. Parker Road #872 |
Address 2 | |
City | Parker |
State/Country | COLORADO |
Mailing Zip/ Postal Code | 80134 |
Phone | 720-600-7121 |
Commission File Number(s) | 024-11362 |
1-Z: PART I Summary Information Regarding the Offering and Proceeds
Summary Information
Date of qualification of the offering statement | 03-19-2021 |
Date of commencement of the offering | 03-19-2021 |
Amount of securities qualified to be sold in the offering | 20000000 |
Amount of securities sold in the offering | 57450 |
Price per security: | $ 1.0000 |
The portion of aggregate sales attributable to securities sold on behalf of the issuer | $ 57450.00 |
The portion of aggregate sales attributable to securities sold on behalf of selling securityholders: | $ 0.00 |
Fees in connection with this offering and names of service providers.
Underwriters - Name of Service Provider | Entoro Securities, LLC | Underwriters - Fees | $ 20000.00 |
Sales Commissions - Name of Service Provider | Entoro Securities, LLC | Sales Commissions - Fee | $ 577.01 |
Finders' Fees - Name of Service Provider | Finders' Fees - Fees | $ | |
Accounting or Audit - Name of Service Provider | George Dimov CPA | Accounting or Audit - Fees | $ 10500.00 |
Legal - Name of Service Provider | Doida Law Group LLC, Crowdcheck Inc. | Legal - Fees | $ 52500.00 |
Promoters - Name of Service Provider | Promoters - Fees | $ | |
Blue Sky Compliance - Name of Service Provider | Doida Law Group LLC | Blue Sky Compliance - Fees | $ 10000.00 |
CRD Number of any broker or dealer listed | 35192 |
Net proceeds to the issuer | $ 0.00 |
Clarification of responses (if necessary): |
1-Z: PART II Certification of Suspension of Duty to File Reports
Certification
Title of each class of securities covered by this Form | Class A Voting Common Stock |
Commission File Number(s) | 024-11362 |
Approximate number of holders of record as of the certification date | 2 |
Certification
Title of each class of securities covered by this Form | Class B Non-voting Common Stock |
Commission File Number(s) | 024-11362 |
Approximate number of holders of record as of the certification date | 140 |
1-Z: Signature
Signature
Pursuant to the requirements of Regulation A,
Cik | 0001831191 |
(Name of issuer as specified in charter) | Revival AI Inc. |
certifies that it meets all of the conditions for termination of Regulation A reporting specified in Rule 257(d) and that there are no classes of securities other than those that are the subject to this Form 1-Z regarding which the issuer has Regulation A reporting obligations.
(Name of issuer as specified in charter) | Revival AI Inc. |
By | Kristin Robinson |
Date | 04-27-2022 |
Title | Principal Executive Officer |