-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, C6RUwrpQRVHvFDMAB5g9ZzYo53Zggu8f+cyH6saQsIDGvFKbK1p5oUdvWxUpZeMI OLpIuP/LoLFqXk4Rl7THoA== 0001096906-08-001680.txt : 20080827 0001096906-08-001680.hdr.sgml : 20080827 20080827153611 ACCESSION NUMBER: 0001096906-08-001680 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20080724 FILED AS OF DATE: 20080827 DATE AS OF CHANGE: 20080827 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AXS ONE INC CENTRAL INDEX KEY: 0000947427 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 132966911 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: MEADOWS OFFICE COMPLEX STREET 2: 301 RT 17 NORTH CITY: RUTHERFORD STATE: NJ ZIP: 07070 BUSINESS PHONE: 2019353400 MAIL ADDRESS: STREET 1: MEADOWS OFFICE COMPLEX STREET 2: 301 ROUTE 17 NORTH CITY: RUTHERFORD STATE: NJ ZIP: 07070 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: JURIKA WILLIAM K CENTRAL INDEX KEY: 0001143989 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13591 FILM NUMBER: 081042003 BUSINESS ADDRESS: STREET 1: 3 SANDRINGHAM PLACE CITY: PIEDMONT STATE: CA ZIP: 94611 BUSINESS PHONE: 5105308032 MAIL ADDRESS: STREET 1: 42 GLEN ALPINE ROAD CITY: PIEDMONT STATE: CA ZIP: 94611 4 1 primary_doc.xml PRIMARY DOCUMENT X0303 4 2008-07-24 0 0000947427 AXS ONE INC AXO 0001143989 JURIKA WILLIAM K 42 GLEN ALPINE ROAD PIEDMONT CA 94611 0 0 1 0 Common Stock Purchase Warrant 2008-07-24 4 J 0 2000000 A 2008-07-24 Common Stock 2000000 2000000 I By Jurika Family Trust U/A 1989 Secured Convertible Promissory Note 2008-07-24 4 J 0 1000000 A 2008-07-24 Common Stock 3000000 3000000 I By Jurika Family Trust, U/A 1989 This Common Stock Purchase Warrant was given by AXS-One to the Jurika Family Trust U/A 1989 as partial consideration for a $1Million loan, as described below. This Secured Convertible Promissory Note was given by AXS-One to the Jurika Family Trust U/A 1989 in connection with a $1Million loan. This Note is convertible at any time, the conversion rate being $1.00. /William K. Jurika/, Trustee 2008-08-26 -----END PRIVACY-ENHANCED MESSAGE-----