(Department of Business Oversight Use Only) | DEPARTMENT OF BUSINESS OVERSIGHT FILE NO., if any: | |
___________________________Fee paid $ | ___________________________ | |
___________________________Receipt No. | Insert File Number(s) of Previous Filings Before the Department, if any. |
1
COMMISSIONER OF BUSINESS OVERSIGHT STATE OF CALIFORNIA
FIRST NOTICE OF TRANSACTION PURSUANT TO CORPORATIONS CODE SECTION 25102(n)
Check One: () Transaction under Section 25102(n)
() Transaction under Rule 260.103 with Notice pursuant to Section 25102(n)
FEE: $600.00 (For Section 25102(n) filings including transactions under Section 25102(n) and Rule 260.103) See Corporations Code Section 25608(x)
Street | City | State | ZIP | |
Mailing Address:_____________________________________________________ | ||||
Street | City | State | ZIP |
___________________________
() Issuer is a California corporation.
() Issuer is a foreign corporation subject to Corporations Code Section 2115. Issuer's state (or other jurisdiction) of incorporation or organization:______________________________.
___________________________
() Issuer is another form of business entity organized under the laws of California (specify):
.
___________________________
___________________________
() Disclosure statements will be provided to each purchaser at least five business days before the securities are sold to the purchaser; or
() Disclosure statements will not be provided based on the fact that all purchasers fall within Rule 206.102.13.
() Copies of the disclosure statements and subscription agreements are attached; or
() Copies of the disclosure statements and subscription agreements will be filed with the Commissioner within 10 days of filing this notice. Failure to comply with this request may result in an administrative penalty of up to $1,000.
() A general announcement of the offering was not made and will not be made.
() A copy of the general announcement of the offering is enclosed with this notice.
___________________________
Date of Publication:
___________________________
Method of Publication (e.g., newspaper, other publications, Internet):
___________________________11. Date of First Notice: | ___________________________ | |
Issuer |
() | Check if issuer already has a consent to | ___________________________ |
service of process on file with the Commissioner. | Authorized Signature on behalf of Issuer |
__________
Print name and title of signatory
Name, Address, and Phone number of contact person:
___________________________
___________________________
___________________________
Instruction: Each issuer (other than a California Corporation) filing a notice under Section 25102(n) must also file a Consent to Service of Process (Form 260.165), unless it already has a valid consent to service on file with the Commissioner.
First Notice - Section 25102(n)
INSTRUCTIONS FOR FILING THE FIRST NOTICE
The Heading. If the issuer has previously qualified securities with the Department, insert the file number of the qualification in the upper right hand corner of the form in the space provided. The fee for filing the First Notice of Transaction is $600.00. There is no filing fee for the Second Notice of Transaction. A transaction under Rule 260.103 with a Notice pursuant to Section 25102(n) requires a $600.00 filing fee.
Item 1. Give the issuer's legal name.
Item 2. Give the street address, and the mailing address if different, of the issuer's principal place of business.
Item 3. Give the telephone number of issuer's principal place of business.
Item 4. Indicate the incorporation or organization of the issuer. Only entities organized in California (other than foreign corporations subject to Corporations Code Section 2115) may claim this exemption. If the issuer is a foreign corporation subject to Corporations Code Section 2115, provide the name of the jurisdiction where issuer is domiciled. If the issuer is another form of business entity organized under the laws of California, specify the type of business entity.
Item 5. Set forth the name or title of each class or type of security to be sold in the transaction.
Item 6. If the transaction was registered under the Securities Act of 1933, insert "registered". If conducted pursuant to an exemption from registration under that Act which requires a filing with the Securities and Exchange Commission, indicate the number of the rule pursuant to which the filing was made. If no such filing was required, insert "none".
Item 7. Indicate whether or not disclosure statements will be distributed.
Item 8. Indicate if disclosure statements are attached to the notice or if they will be submitted within 10 days of the Commissioner's request for the information.
Item 9. Indicate how the general announcement of the offering was made.
Item 10. Set forth the undertaking language required by Corporations Code Section 25102(n)(7).
Item 11. Date and Signature. The notices should be signed by an authorized officer, director, general partner or trustee of the issuer (or a person occupying a position with the issuer of equivalent responsibility) or by the authorized attorney of the issuer. If the person the Department is to contact in the event of questions concerning the transaction is different from the signer, insert the contact person's name, telephone number and correspondence address in the spaces provided. Otherwise, provide this information with respect to the signer.
Filing Fee. Each First Notice under 25102(n) must be accompanied by the filing fee required by Section 25608(x) of the Code.
Corporations Code Section 25165 requires each issuer, other than a California corporation, to file a consent to service of process with the Notices filed pursuant to Section 25102(n) unless it already has a consent to service on file with the Commissioner. Use Form 260.165 (see Rule 260.165, Title 10, California Code of Regulations).
(Department of Business Oversight Use Only) | DEPARTMENT OF BUSINESS OVERSIGHT FILE NO., if any: | |
___________________________Fee paid with First Notice $ | ___________________________ | |
Insert File Number(s) of Previous Filings Before the Department, if any. |
2
COMMISSIONER OF BUSINESS OVERSIGHT STATE OF CALIFORNIA
SECOND NOTICE OF TRANSACTION PURSUANT TO CORPORATIONS CODE SECTION 25102(n)
Check One: () Transaction under Section 25102(n)
() Transaction under Rule 260.103 with Notice pursuant to Section 25102(n)
___________________________
___________________________
Street | City | State | ZIP | |
Mailing Address:__________________________________________ | ||||
Street | City | State | ZIP |
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________8. Date of Second Notice: | ___________________________ | |
Issuer |
() | Check if issuer already has a consent to | ___________________________ |
service of process on file with the Commissioner. | Authorized Signature on behalf of Issuer | |
___________________________
Print name and title of signatory
Name, Address, and Phone number of contact person:
___________________________
___________________________
___________________________
Instruction: Each issuer (other than a California Corporation) filing a notice under Section 25102(n) must file a Consent to Service of Process (Form 260.165), unless it already has a consent to service on file with the Commissioner.
Second Notice - Section 25102(n)INSTRUCTIONS FOR FILING THE SECOND NOTICE.
The Heading. If the issuer has previously qualified securities with the Department, insert the file number of the qualification in the upper right hand corner of the form in the space provided. There is no fee for filing the Second Notice of Transaction.
Item 1. Give the issuer's legal name.
Item 2. Give the street address, and the mailing address if different, of the issuer's principal place of business.
Item 3. Give the telephone number of the issuer's principal place of business.
Item 4. Give the date the First Notice was filed with the Department of Business Oversight.
Item 5. Give the date the offering was closed or abandoned.
Item 6. Set forth the name or title of each class or type of security to be sold in the transaction.
Item 7. If the transaction was registered under the Securities Act of 1933, insert "registered". If conducted pursuant to an exemption from registration under that Act which requires a filing with the Securities and Exchange Commission, indicate the number of the rule pursuant to which such filing was made. If no such filing was required, insert "none."
Item 8. Date and Signature. The notice should be signed by an authorized officer, director, general partner or trustee of the issuer (or a person occupying a position with the issuer of equivalent responsibility) or by the authorized attorney of the issuer. If the person the Department is to contact in the event of questions concerning the transaction is different from the signer, insert the contact person's name, telephone number and correspondence address in the spaces provided. Otherwise, provide this information with respect to the signer.
Corporations Code Section 25165 requires each issuer, other than a California corporation, to file a consent to service of process with the Notices filed pursuant to Section 25102(n) unless it already has a consent to service on file with the Commissioner. Use Form 260.165 (see Rule 260.165, Title 10, California Code of Regulations).
Cal. Code Regs. Tit. 10, § 260.102.16
2. Editorial correction of First Notice form (Register 96, No. 52).
3. Editorial correction of subsections (a)(2) and (c) (Register 98, No. 32).
4. Amendment of forms and instructions thereto filed 8-5-98; operative 9-4-98 (Register 98, No. 32).
5. Change without regulatory effect amending section filed 9-25-2002 pursuant to section 100, title 1, California Code of Regulations (Register 2002, No. 39).
6. Change without regulatory effect amending subsections (d) and (e) filed 8-13-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 33).
Note: Authority cited: Sections 25165 and 25610, Corporations Code. Reference: Sections 25102(n), 25165 and 25608, Corporations Code.
2. Editorial correction of First Notice form (Register 96, No. 52).
3. Editorial correction of subsections (a)(2) and (c) (Register 98, No. 32).
4. Amendment of forms and instructions thereto filed 8-5-98; operative 9-4-98 (Register 98, No. 32).
5. Change without regulatory effect amending section filed 9-25-2002 pursuant to section 100, title 1, California Code of Regulations (Register 2002, No. 39).
2. Editorial correction of First Notice form (Register 96, No. 52).
3. Editorial correction of subsections (a)(2) and (c) (Register 98, No. 32).
4. Amendment of forms and instructions thereto filed 8-5-98; operative 9-4-98 (Register 98, No. 32).
5. Change without regulatory effect amending section filed 9-25-2002 pursuant to section 100, title 1, California Code of Regulations (Register 2002, No. 39).
6. Change without regulatory effect amending subsections (d) and (e) filed 8-13-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 33).
2. Editorial correction of First Notice form (Register 96, No. 52).
3. Editorial correction of subsections (a)(2) and (c) (Register 98, No. 32).
4. Amendment of forms and instructions thereto filed 8-5-98; operative 9-4-98 (Register 98, No. 32).
5. Change without regulatory effect amending section filed 9-25-2002 pursuant to section 100, title 1, California Code of Regulations (Register 2002, No. 39).
6. Change without regulatory effect amending subsections (d) and (e) filed 8-13-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 33).