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 COMMISSION Washington, D.C. 20549 FORM D Notice of Exempt Offering of Securities OMB APPROVAL OMB Number: Estimated average burden hours per response: 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 OH-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 c/o 19230 OH-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 Toole Eric Street Address 1 Street Address 2 c/o 19230 OH-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 Gustin Roy Street Address 1 Street Address 2 c/o 19230 OH-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 Naylor Daniel Street Address 1 Street Address 2 c/o 19230 OH-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 c/o 19230 OH-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 Foster Alan Street Address 1 Street Address 2 c/o 19230 OH-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 Applegate Tony Street Address 1 Street Address 2 c/o 19230 OH-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 Greene Matthew Street Address 1 Street Address 2 c/o 19230 OH-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 Baxla Chris Street Address 1 Street Address 2 c/o 19230 OH-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 Wilson Chad Street Address 1 Street Address 2 c/o 19230 OH-136 City State/Province/Country ZIP/PostalCode Winchester OHIO Relationship: Executive Officer Director Promoter Clarification of Response (if Necessary): 4.