[1-Z] XY Labs, Inc. SEC Filing

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Form 1-Z Issuer Information	UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 1-Z EXIT REPORT UNDER REGULATION A	OMB APPROVAL
FORM 1-Z		OMB Number: 3235-0723 Estimated average burden hours per response: 1.5

1-Z: Filer Information

Issuer CIK
Issuer CCC
File Number
Is this filing by a successor company pursuant to Rule 257(b)(5) resulting from a merger or other business combination?	Yes No
Successor File Number

Is this a LIVE or TEST Filing?	LIVE TEST
Is this an electronic copy of an official filing submitted in paper format?
Would you like a Return Copy?

Submission Contact Information

Name

Phone

E-Mail Address

Notify via Filing Website only?

1-Z: PRELIMINARY INFORMATION

Exact name of issuer as specified in the issuer's charter

Address of Principal Executive Offices

Address 1

Address 2

City

State/Country

Mailing Zip/ Postal Code

Phone

Commission File Number(s)

1-Z: PART II Certification of Suspension of Duty to File Reports

Certification

Title of each class of securities covered by this Form

Commission File Number(s)

Approximate number of holders of record as of the certification date

1-Z: Signature

Signature

Pursuant to the requirements of Regulation A,

Cik

(Name of issuer as specified in charter)

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)

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

By

Date

Title

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.