The Securities and Exchange Commission has not necessarily reviewed the information in this filing and has not determined if it is accurate and complete.The reader should not assume that the information is accurate and complete.
UNITED STATES SECURITIES AND EXCHANGE COMMISSIONWashington, D.C. 20549FORM DNotice of Exempt Offering of Securities
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1. Issuer's Identity
CIK (Filer ID Number)
Previous Names
None
Entity Type
Corporation
Limited Partnership
Limited Liability Company
General Partnership
Business Trust
Other (Specify)
Name of Issuer
FIRST STATE BANCORP INC
Jurisdiction of Incorporation/Organization
OHIO
Year of Incorporation/Organization
Over Five Years Ago
Within Last Five Years (Specify Year)
Yet to Be Formed
2. Principal Place of Business and Contact Information
Name of Issuer
FIRST STATE BANCORP INC
Street Address 1
Street Address 2
19230 State Route 136
City
State/Province/Country
ZIP/PostalCode
Phone Number of Issuer
Winchester
OHIO
3. Related Persons
Last Name
First Name
Middle Name
Pell
Michael
Street Address 1
Street Address 2
19230 State Route 136
City
State/Province/Country
ZIP/PostalCode
Winchester
OHIO
Relationship:
Executive Officer
Director
Promoter
Clarification of Response (if Necessary):
Last Name
First Name
Middle Name
Richey
David
Street Address 1
Street Address 2
19230 State Route 136
City
State/Province/Country
ZIP/PostalCode
Winchester
OHIO
Relationship:
Executive Officer
Director
Promoter
Clarification of Response (if Necessary):
Last Name
First Name
Middle Name