Pricing

Form D

Form D for PERMA FIX ENVIRONMENTAL SERVICES INC

Accession Number: 0001144204-09-028923
Date: 2009-05-21
Edgar Link
FORM D
Notice of Exempt Offering of Securities

UNITED STATES SECURITIES
AND EXCHANGE COMMISSION
Washington, D.C.

OMB APPROVAL
OMB Number: 3235-0076
Estimated Average burden hours per response: 4.0
1. Issuer's Identity
CIK (Filer ID Number) Previous Name(s)  Checkbox checked None Entity Type
0000891532
 Radio button checked Corporation
 Radio button not checked Limited Partnership
 Radio button not checked  Limited Liability Company
 Radio button not checked  General Partnership
 Radio button not checked  Business Trust
 Radio button not checked Other 
Name of Issuer
 PERMA FIX ENVIRONMENTAL SERVICES INC
Jurisdiction of Incorporation/Organization
DE 
Year of Incorporation/Organization
 Radio button checked Over Five Years Ago
 Radio button not checked Within Last Five Years (Specify Year)
 
 Radio button not checked Yet to Be Formed
 
  
  
 
2. Principal Place of Business and Contact Information
Name of Issuer
 PERMA FIX ENVIRONMENTAL SERVICES INC
Street Address 1 Street Address 2
 8302 Dunwoody Place, Suite 250
 
City State/Province/Country ZIP/Postal Code Phone No. of Issuer
 Atlanta
 GA
 
 30350
 (770) 587-9898 




3. Related Persons

Last Name First Name Middle Name
Centofanti
Dr. Louis
F.
Street Address 1 Street Address 2
 8302 Dunwoody Place, Suite 250 
 
City State/Province/Country ZIP/Postal Code
 Atlanta
 GA
 30350
 
Relationship:  Checkbox checked Executive Officer  Checkbox checked Director  Checkbox not checked Promoter
Clarification of Response (if Necessary)



Last Name First Name Middle Name
Naccarato
Ben
 
Street Address 1 Street Address 2
 8302 Dunwoody Place, Suite 250 
 
City State/Province/Country ZIP/Postal Code
 Atlanta
 GA
 30350
 
Relationship:  Checkbox checked Executive Officer  Checkbox not checked Director  Checkbox not checked Promoter
Clarification of Response (if Necessary)



Last Name First Name Middle Name
McNamara
Larry
 
Street Address 1 Street Address 2
 8302 Dunwoody Place, Suite 250 
 
City State/Province/Country ZIP/Postal Code
 Atlanta
 GA
 30350
 
Relationship:  Checkbox checked Executive Officer  Checkbox not checked Director  Checkbox not checked Promoter
Clarification of Response (if Necessary)



Last Name First Name Middle Name
Schreiber, Jr.
Robert
 
Street Address 1 Street Address 2
 8302 Dunwoody Place, Suite 250 
 
City State/Province/Country ZIP/Postal Code
 Atlanta
 GA
 30350
 
Relationship:  Checkbox checked Executive Officer  Checkbox not checked Director  Checkbox not checked Promoter
Clarification of Response (if Necessary)
President of Schreiber Yonley Associates



Last Name First Name Middle Name
Colin
Jon
 
Street Address 1 Street Address 2
 4 Carousel Court 
 Millstone Township
City State/Province/Country ZIP/Postal Code
 Freehold
 NJ
 08510
 
Relationship:  Checkbox not checked Executive Officer  Checkbox checked Director  Checkbox not checked Promoter
Clarification of Response (if Necessary)



Last Name First Name Middle Name
Lahav
Jack
 
Street Address 1 Street Address 2
 6 Bellcourt Place 
 
City State/Province/Country ZIP/Postal Code
 Livingston
 NJ
 07039
 
Relationship:  Checkbox not checked Executive Officer  Checkbox checked Director  Checkbox not checked Promoter
Clarification of Response (if Necessary)



Last Name First Name Middle Name
Reeder
Joe
R.
Street Address 1 Street Address 2
 106 West Rosemont Avenue 
 
City State/Province/Country ZIP/Postal Code
 Alexandria
 VA
 22301
 
Relationship:  Checkbox not checked Executive Officer  Checkbox checked Director  Checkbox not checked Promoter
Clarification of Response (if Necessary)



Last Name First Name Middle Name
Zwecker
Mark
A.
Street Address 1 Street Address 2
 1042 Cumberland Road 
 
City State/Province/Country ZIP/Postal Code
 Atlanta
 GA
 30306
 
Relationship:  Checkbox not checked Executive Officer  Checkbox checked Director  Checkbox not checked Promoter
Clarification of Response (if Necessary)



Last Name First Name Middle Name
Shelton
Larry
 
Street Address 1 Street Address 2
 2531 Scenic Drive 
 
City State/Province/Country ZIP/Postal Code
 Salt Lake City
 UT
 84109
 
Relationship:  Checkbox not checked Executive Officer  Checkbox checked Director  Checkbox not checked Promoter
Clarification of Response (if Necessary)



Last Name First Name Middle Name
Young
Dr. Charles
 
Street Address 1 Street Address 2
 1668 Abbotsbury Street 
 
City State/Province/Country ZIP/Postal Code
 Thousand Oaks
 CA
 91361
 
Relationship:  Checkbox not checked Executive Officer  Checkbox checked Director  Checkbox not checked Promoter
Clarification of Response (if Necessary)



Last Name First Name Middle Name
Ferguson
Robert
L.
Street Address 1 Street Address 2
 121 Fairwood Court 
 
City State/Province/Country ZIP/Postal Code
 Richland
 WA
 99352
 
Relationship:  Checkbox not checked Executive Officer  Checkbox checked Director  Checkbox not checked Promoter
Clarification of Response (if Necessary)





4. Industry Group
  Radio button not checked Agriculture
Banking & Financial Services
   Radio button not checked   Commercial Banking
   Radio button not checked   Insurance
   Radio button not checked Investing
   Radio button not checked   Investment Banking
   Radio button not checked   Pooled Investment Fund

   Radio button not checked Other Banking & Financial Services
 Radio button not checked   Business Services
Energy
   Radio button not checked   Coal Mining
   Radio button not checked   Electric Utilities
   Radio button not checked   Energy Conservation
   Radio button not checked   Environmental Services
   Radio button not checked   Oil & Gas
   Radio button not checked   Other Energy
Health Care
   Radio button not checked   Biotechnology
   Radio button not checked   Health Insurance
   Radio button not checked   Hospitals & Physicians
   Radio button not checked   Pharmaceuticals
   Radio button not checked   Other Health Care
     
     
     
   
 Radio button not checked   Manufacturing
Real Estate
   Radio button not checked Commercial
   Radio button not checked Construction
   Radio button not checked REITS & Finance
   Radio button not checked Residential
 Radio button not checked Other Real Estate
 Radio button not checked   Retailing
 Radio button not checked Restaurants
Technology
 Radio button not checked   Computers
 Radio button not checked   Telecommunications
 Radio button not checked  Other Technology
Travel
 Radio button not checked  Airlines & Airports
 Radio button not checked  Lodging & Conventions
 Radio button not checked  Tourism & Travel Services
 Radio button not checked  Other Travel
 Radio button checked Other

  
   
5. Issuer Size
Revenue Range Aggregate Net Asset Value Range
 Radio button not checked No Revenues  Radio button not checked   No Aggregate Net Asset Value
 Radio button not checked   $1 - $1,000,000  Radio button not checked $1 - $5,000,000
 Radio button not checked   $1,000,001 - $5,000,000  Radio button not checked   $5,000,001 - $25,000,000
 Radio button not checked $5,000,001 - $25,000,000  Radio button not checked   $25,000,001 - $50,000,000
 Radio button checked $25,000,001 - $100,000,000  Radio button not checked   $50,000,001 - $100,000,000
 Radio button not checked   Over $100,000,000  Radio button not checked   Over $100,000,000
 Radio button not checked   Decline to Disclose   Radio button not checked Decline to Disclose
 Radio button not checked   Not Applicable  Radio button not checked   Not Applicable

 
6. Federal Exemption(s) and Exclusion(s) Claimed (select all that apply)
 Checkbox not checked Rule 504(b)(1) (not (i), (ii)
or (iii))
 Checkbox not checked Rule 506(b)        
 Checkbox not checked Rule 504 (b)(1)(i)  Checkbox not checked Rule 506(c)
 Checkbox not checked Rule 504 (b)(1)(ii)  Checkbox not checked Securities Act Section 4(a)(5)
 Checkbox not checked Rule 504 (b)(1)(iii)  Checkbox not checked Investment Company Act Section 3(c)
 
 

7. Type of Filing
 Checkbox checked   New Notice Date of First Sale 
2009-05-08
 Checkbox not checked   First Sale Yet to Occur
 Checkbox not checked   Amendment


 
 
8. Duration of Offering
Does the Issuer intend this offering to last more than one year?  Radio button checked   Yes  Radio button not checked   No
 
 
9. Type(s) of Securities Offered (select all that apply)
 Checkbox not checked Pooled Investment Fund Interests  Checkbox checked Equity
 Checkbox not checked Tenant-in-Common Securities  Checkbox not checked Debt
 Checkbox not checked Mineral Property Securities  Checkbox checked Option, Warrant or Other Right to Acquire Another Security
 Checkbox not checked Security to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire Security  Checkbox not checked Other (describe)
 
 
 
10. Business Combination Transaction
Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer?  Radio button not checked   Yes  Radio button checked   No
Clarification of Response (if Necessary)
 
 
 
11. Minimum Investment
Minimum investment accepted from any outside investor $
 0
USD

12. Sales Compensation
Recipient  Recipient CRD Number  Checkbox not checked None
 
 
(Associated) Broker or Dealer  Checkbox not checked None (Associated) Broker or Dealer CRD Number   Checkbox not checked None
 
 
Street Address 1 Street Address 2
 
 
City State/Province/Country ZIP/Postal Code
 
 
 
State(s) of Solicitation   Checkbox not checked All States
 



13. Offering and Sales Amounts
 
Total Offering Amount $
 
USD  Checkbox checked Indefinite
Total Amount Sold $
476000
USD
Total Remaining to be Sold $
 
USD  Checkbox checked Indefinite
Clarification of Response (if Necessary)
Please see Item 5 of Issuer's Form 10-Q for the quarter ended March 31, 2009, filed with the Securities and Exchange Commission on May 11, 2009
 
14. Investors

 Checkbox not checked Select if securities in the offering have been or may be sold to persons who do not qualify as accredited investors,
Number of such non-accredited investors who already have invested in the offering
   
  Regardless of whether securities in the offering have been or may be sold to persons who do not qualify as accredited investors, enter the total number of investors who already have invested in the offering:
2
 
15. Sales Commissions & Finders’ Fees Expenses
Provide separately the amounts of sales commissions and finders' fees expenses, if any. If the amount of an expenditure is not known, provide an estimate and check the box next to the amount.
Sales Commissions $
0
USD  Checkbox not checked Estimate
Finders' Fees $
0
USD  Checkbox not checked Estimate
Clarification of Response (if Necessary)
 
 

16. Use of Proceeds
Provide the amount of the gross proceeds of the offering that has been or is proposed to be used for payments to any of the persons required to be named as executive officers, directors or promoters in response to Item 3 above. If the amount is unknown, provide an estimate and check the box next to the amount.
  $ 
0
USD  Checkbox not checked Estimate
Clarification of Response (if Necessary)
 

Signature and Submission
 
Please verify the information you have entered and review the Terms of Submission below before signing and clicking SUBMIT below to file this notice.
Terms of Submission 
  In submitting this notice, each Issuer named above is:  
 
  • Notifying the SEC and/or each State in which this notice is filed of the offering of securities described and undertaking to furnish them, upon written request, the information furnished to offerees.
  • Irrevocably appointing each of the Secretary of the SEC and, the Securities Administrator or other legally designated officer of the State in which the Issuer maintains its principal place of business and any State in which this notice is filed, as its agents for service of process, and agreeing that these persons may accept service on its behalf, of any notice, process or pleading, and further agreeing that such service may be made by registered or certified mail, in any Federal or state action, administrative proceeding, or arbitration brought against it in any place subject to the jurisdiction of the United States, if the action, proceeding or arbitration (a) arises out of any activity in connection with the offering of securities that is the subject of this notice, and (b) is founded, directly or indirectly, upon the provisions of:  (i) the Securities Act of 1933, the Securities Exchange Act of 1934, the Trust Indenture Act of 1939, the Investment Company Act of 1940, or the Investment Advisers Act of 1940, or any rule or regulation under any of these statutes, or (ii) the laws of the State in which the issuer maintains its principal place of business or any State in which this notice is filed.
  • Certifying that, if the issuer is claiming a Regulation D exemption for the offering, the issuer is not disqualified from relying on Rule 504 or Rule 506 for one of the reasons stated in Rule 504(b)(3) or Rule 506(d).
 
Each Issuer identified above has read this notice, knows the contents to be true, and has duly caused this notice to be signed on its behalf by the undersigned duly authorized person.
For signature, type in the signer's name or other letters or characters adopted or authorized as the signer's signature.
 
Issuer Signature Name of Signer Title Date
Perma-Fix Environmental Services, Inc. /s/ Ben Naccarato Ben Naccarato Chief Financial Officer 2009-05-21