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Revival AI Inc. – ‘1-Z’ on 4/29/22

On:  Friday, 4/29/22, at 3:26pm ET   ·   Accession #:  1193125-22-133318

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  As Of               Filer                 Filing    For·On·As Docs:Size             Issuer                      Filing Agent

 4/29/22  Revival AI Inc.                   1-Z                    1:4K                                     Donnelley … Solutions/FA

Exit Report   —   Form 1-Z   —   Regulation A

Filing Table of Contents

Document/Exhibit                   Description                      Pages   Size 

 1: 1-Z         Exit Report -- primary_doc.xml                      HTML      5K


        

This ‘1-Z’ Document is an XML Data File that may be rendered in various formats:

  Form 1-Z    –   Plain Text   –  SEC Website  –  EDGAR System  –    XML Data    –  <?xml?> File
 
 
SEC Info℠ rendering:  Exit Report
 
schemaVersion:

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? Radio button not checked Yes Radio button checked No
Successor File Number
 
Is this a LIVE or TEST Filing? Radio button checked LIVE Radio button not checked TEST
Is this an electronic copy of an official filing submitted in paper format? Checkbox not checked
Would you like a Return Copy? Checkbox not checked

Submission Contact Information

Name
 
Phone
 
E-Mail Address
 
Notify via Filing Website only? Checkbox not checked

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

3/19/21 

Date of commencement of the offering

3/19/21 

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.

Has caused this certification to be signed on its behalf by the undersigned duly authorized person.

By

Kristin Robinson 

Date

4/27/22 

Title

Principal Executive Officer

Instructions: This Part II of Form 1-Z is required by Rule 257(d) of Regulation A. An officer of the issuer or any other duly authorized person may sign, and must do so by typed signature. The name and title of the person signing the form must be typed or printed under the signature. The signatory to the filing must also manually sign a signature page or other document authenticating, acknowledging or otherwise adopting his or her signature that appears in the filing. Such document must be executed before or at the time the filing is made and must be retained by the issuer for a period of five years. Upon request, the issuer must furnish to the Commission or its staff a copy of any or all documents retained pursuant to this instruction.


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