FORM B

DISCLOSURE OF COMPENSATION OF
PRINCIPAL, OFFICER, DIRECTOR OR INSIDER

Name:  ___________________________   Capacity:   ___	Principal
						___	Officer
						___	Director
						___	Insider

Detailed Description of Duties: _____________________________
_____________________________________________________________
_____________________________________________________________


Current Compensation Paid:   		Weekly		or	Monthly

					__________		___________

Current Benefits Received:		Weekly		or	Monthly

	Health Insurance		__________		___________

	Life Insurance			__________		___________

	Retirement			__________		___________

	Company Vehicle			__________		___________

	Entertainment			__________		___________

	Travel				__________		___________

	Other Benefits			__________		___________

	CURRENT TOTAL:			__________		___________



Prior Year Annual Salary Total:       $ _________________


Dated:	____________			____________________________________
					Principal, Officer, Director, Insider