La. Admin. Code tit. 48 § XXV-307

Current through Register Vol. 50, No. 9, September 20, 2024

Section XXV-307 - Filing of Applications and Additional Documents

A. Filing of Applications

1. Applications shall be filed by delivering an original and three copies to the director.

2. The filing date of a conforming application shall be the date the department determines the application to be a completed application.

3. No application shall be filed by facsimile machine.

4. Applications filed with the department become property of the state.

5. Applications shall be accompanied with the filing fee as determined by §309 in accordance with R.S. 40:2115.22.

6. The application must include the contents of application.

7. The application shall be submitted to the attorney general on the forms provided and include the information requested therein.

8. The department may at any time request any other supplemental or additional documentation, disclosures, information, etc., as it deems necessary to the evaluation. The applicant shall provide the information not later than 10 days after the date of the request.

9. The application must be in the following format.

a. Applications shall be submitted to the attorney general on the forms provided and in accordance with the instructions therein.

b. Trade secret information shall be printed on goldenrod colored paper to assist in identifying material exempt from the Louisiana Public Records Act.

c. Applications which do not comply with these rules shall not be accepted and will be returned to the applicant.

B. Forms

LOUISIANA ATTORNEY GENERAL'S APPLICATION

REQUEST FOR INFORMATION FORM

FOR CERTAIN NONPROFIT MERGERS, SALES, AND ACQUISITIONS

PLEASE CAREFULLY REVIEW THE INSTRUCTIONS AND

DEFINITIONS FORM PRIOR TO COMPLETING THIS FORM

1. Name of Nonprofit to be Acquired: Identify each and every nonprofit entity or entities (hereinafter "nonprofit") which is the subject of an impending acquisition in accordance with R.S. 40:2115 et seq.

_______________________________________________

2. Contact Person for Nonprofit: Provide the full legal name, title, address, telephone and facsimile number for the contact person regarding this Form (this individual will also receive any requests for additional information for documents):

_______________________________________________

3. Directors and Officers: Identify by full legal name and title each and every director and officer of the nonprofit.

_______________________________________________

4. Corporate Documents of Nonprofit: Attach as Appendix A, all corporate documents relating to the nonprofit entity and selected entities filing this Request. Include corporate documents of all parents, subsidiaries, or affiliates of the nonprofit. For the purpose of this Request, "corporate documents" means the charter or articles of incorporation, bylaws, and any and all amendments to each corporate document.

5. Name of Acquirer: Identify the proposed acquirer of the nonprofit (hereinafter "acquirer") identified in Request #1. Include in your response the identity of any (a) parent, (b) subsidiary, and/or (c) affiliate of the acquirer.

_______________________________________________

6. Contact Person for Acquirer: Provide the full legal name, title, address, telephone, and facsimile number of the contact person for the acquirer.

_______________________________________________

7. Corporate Documents of Acquirer: Attach as Appendix B copies of all corporate documents relating to the acquirer identified in Request #4.

8. Value of Nonprofit Assets: What is the aggregate approximate value of the nonprofit assets to be acquired in the proposed transaction?

9. Description of Proposed Transaction: Attach as Appendix C a detailed description of the proposed transaction, including a detailed explanation of what is to be acquired by the acquirer, what is to be retained by the nonprofit(s), and the resulting funds to be received by the nonprofit(s). This should also include an analysis of the purchase price, based upon the nonprofit's interpretation of the letter of intent or definitive contract. The analysis should begin with the nonprofit's balance sheet, should consider the impact of any fund balances and/or liabilities to be retained by the resulting foundation, and end with a resulting fund balance for the proposed foundation to be created. This analysis should include reasonable estimates for any proposed purchase price adjustments called for in the letter of intent or definitive agreement. The objective of this analysis is to enable the Office of the Attorney General to understand the pricing of the transaction and the capitalization of any resulting foundation.

10. Description of Negotiations of the Transaction: Attach as Appendix D a detailed description of all discussions and negotiations between nonprofit and acquirer resulting in the proposed transaction. This response should include, but not be limited to, a summary outline in date sequence of any and all meetings held with the following parties with respect to the proposed transaction:

(a) With the nonprofit's financial advisors or investment bankers related to the proposed transaction (including, but not limited to, management, committees of the board of directors or meetings of the full board);

(b) With prospective purchasers, networkers, merging partners of the nonprofit (or substantially all of the nonprofit), together with a brief summary of the results of such meetings;

(c) With the ultimate acquirer; and

(d) With other parties deemed significant to the transaction (including, but not limited to, outside experts or other consultants).

11. Closing Date: What is the expected date of closing of the proposed transaction?

12. Governmental Filings: Attach as Appendix E all filings with respect to the proposed transaction, including all amendments, appendices, and attachments, and each report or document provided to each federal, state, or local governmental entity regarding the proposed transaction. Include copies of forms to be provided to each such entity, the answer to information or questions on such forms, and each attachment submitted in connection therewith.

13. Meetings with Governmental Officials: Attach as Appendix F summaries of all meetings with federal, state, or local authorities regarding any filings or documents referenced in Request #12. Also, include each and every document which memorializes or discusses any and all meetings or other communications with the United States Department of Justice, Federal Trade Commission, or any other state, federal or local governmental entity in connection with the proposed transaction.

14. Acquirer's Prior Acquisitions: Identify all prior acquisitions by the proposed acquirer with the last three (3) years, including the following information for each:

(a) Date of Acquisition;

(b) Entity Acquired;

(c) City/State;

(d) Brief Description;

(e) Purchase Price; and

(f) Form of Consideration.

15. Letters of Intent: Attach as Appendix G any and all drafts and final versions of any and all letters of intent, confidentiality agreements, or other documents initiating negotiations, contact, or discussion between the acquirer and nonprofit.

16. Contracts or Purchase Agreements: Attach as Appendix H any and all drafts and final versions of asset purchase agreements, contracts or agreements to purchase the nonprofit by the acquirer. Your response must also include any attachments, amendments, schedules, or appendices to such agreements.

17. Fairness Opinions: Attach as Appendix I any and all fairness opinions analyzing the proposed transaction along with any supplemental analysis prepared by the nonprofit or its experts. Include in your response the name of the company and the person(s) who prepared the opinion, their business telephone numbers and addresses, the agreement or engagement letter with such company or person, and background information regarding the company or person's qualifications.

18. Meeting Minutes and Other Information: Attach as Appendix J the following documents with respect to each meeting, whether regular, special, or otherwise, of the board of directors or board of trustees for each nonprofit or acquirer.

(a) Announcements and the persons to whom the announcements were sent;

(b) Agenda;

(c) Minutes and/or resolutions of the board of directors or board of trustees for each nonprofit entity or acquirer which reflect or discuss the proposed transaction, including those regarding the final vote;

(d) Each written report or document provided to the board or board members, including, but not limited to, each committee report and each expert's report;

(e) Each proposal or document referencing or regarding possible or actual sale, merger, acquisitions, or distribution of assets of any nonprofit entity;

(f) Each presentation to the board or any committee to the board; and

(g) Each attachment to (a) through (f).

19. Valuation Information: Attach as Appendix K each appraisal (with each attachment), evaluation (with each attachment), and similar document (with each attachment) concerning the valuation during the last three (3) fiscal years of the nonprofit entities, their assets, their properties, their worth as a going concern, their market value, or their price for sale. This Request shall include, but not be limited to, any appraisals of the common stock of any for-profit subsidiaries of the nonprofit, any appraisals involving property held by the nonprofit.

20. Information Regarding Other Offers: Attach as Appendix K each appraisal (with each attachment), evaluation (with each attachment), and similar document (with each attachment) concerning any negotiation, proposal, or sale either initiated or received by the nonprofit regarding a sale of all or substantially all of its assets, a merger, a joint venture, a combination, an arrangement, a partnership, an acquisition, an alliance, or a networking relationship, and the dollar value of such proposed transaction.

21. Mission Statement: Attach as Appendix M any and all mission statements of the nonprofit.

22. Press Releases and Related Information: Attach as Appendix N any and all press releases, newspaper articles, radio transcripts, audiotapes and videotapes of any television commercials or reports regarding the proposed transaction and any other offers identified in Request # 20.

23. Financial Records: Attach as Appendix O all of the following for the last six (6) fiscal years for both the nonprofit and acquirer, unless otherwise indicated:

(a) Audited and unaudited financial statements. Audits are sometimes presented in abbreviated form or in fuller form, with detailed supplements. Provide the most detailed form of your audit that is available;

(b) Consolidating statements (balance sheets and income statements for each fiscal year);

(c) Year-to-date internal financial statements for the most recent month-end available during the current year. Be sure that the statements are comparative (with the same period of the previous fiscal year), otherwise provide last year's internal financial statements for the corresponding period as well;

(d) If separate audited financial statements are prepared for any of your nonprofit members or affiliates, or any parent or subsidiary of the acquirer, please provide those audits, together with comparative year-to-date financial statements for each such member, affiliate, parent or subsidiary;

(e) For the nonprofit only, projected capital expenditure requirements for the next three (3) years, assuming the nonprofit continues to operate as it has been operating;

(f) Each balance sheet, profit and loss statement, statement of change in financial position of the nonprofit, any entity or company it controls, operates, manages, or is affiliated with and also the same information for the acquirer and any entity which you reasonably believe it owns, operates, manages, or controls;

(g) For the nonprofit only, a detailed schedule of operating expenses, unless already provided with the audits;

(h) For the nonprofit only, an analysis (aging) of accounts receivable by major category, of receivables as of the most recent month-end available, indicating the amounts ultimately considered collectable by the nonprofit;

(i) For the nonprofit only, management compensation (salary, bonus, other benefits) for the five (5) officers of the nonprofit receiving the greatest amount of compensation;

(j) Identify any material off-balance sheet assets or liabilities (i.e., any assets or liabilities not reflected on the most recent audited financial statements) and provide documentation concerning such assets or liabilities. Examples of such items would include a significant under-or over-funding in the pension plan or a current litigation judgment not reflected in the most recent audit;

(k) Identify any material contingent assets or liabilities, and the conditions that must occur for any such contingent assets to be realized or for any such contingent liabilities to be incurred; and

(l) Identify all accounting firms, including the name, address, and telephone number of the accountant(s) primarily responsible for accounting and auditing of the entities for the last six (6) years.

24. Foundation Issues:

(a) Attach as Appendix P the detailed written plan of the preservation, protection, and use of any and all proceeds from the dissolution of the nonprofit, or the sale to or merger with the acquirer. State and fully explain whether any money, property, or proceeds resulting from the transaction referred to in your Notice or the operation of the foundation will benefit any director, officer or for-profit person or entity, directly or indirectly. The detailed plan shall include bylaws, a conflict of interest statement, a defined mission, the proposed investment policy, and granting procedures.

(b) Attach as Appendix Q proof that any asset purchase agreement or other contract, by whatever name, does not incorporate or place any restrictions which any for-profit entity may place on the use of charitable or nonprofit funds and any other funds or property, either now or in the future, by any foundation created or endowed to preserve, disburse, or protect the funds.

(c) Attach as Appendix R a report indicating, showing, explaining, and discussing the properties and assets, whether cash, securities, intangible property, and all other property (listing each encumbrance), available for charitable purposes before and after the transaction and showing or discussing what entity or person will control, manage, operate, deploy, and use the charitable or nonprofit properties or assets. Include in your response the full legal name, title, business address, and telephone number of the individual preparing said report.

25. Existing Foundations or Restricted Donations: Attach as Appendix S any and all documents reflecting any existing foundations or other restricted donations, including, but not limited to, trusts that are designated or intended to benefit the current nonprofit. Include a detailed statement setting forth your intention with regard to such restricted donations.

26. Conflict of Interest, Self-Interest, and Self-Dealing Issues:

(a) Attach as Appendix T an affidavit for each officer and director of the nonprofit.

(b) Attach as Appendix U any and all documents reflecting any possible conflict of interest, self-interest, or self-dealing of any board member, officer, or director in connection with the proposed transaction. Such documents shall include evidence of any disclosures or other curative measures taken by the board and any documents suggesting or referencingfinancial or employment incentives or inducements offered to any board member, director or officer.

(c) Attach as Appendix V each memorandum, report, letter, or other document suggesting or referencing any employment or position (actual or possible) with acquirer for any officer or director of the nonprofit after the transaction is completed, as well as any assets, funds, annuity, deferred compensation or other economic or tangible benefit to be provided, whether or not in exchange for services rendered or to be rendered to any nonprofit or acquirer.

27. Persons Involved in Decision Making of Planning: Attach as Appendix W a list of the full legal names, titles, addresses, and telephone numbers of each and every officer, director, representative, manager, executive, expert or other persons having substantial input, at any phase of decision making or planning, into the decision or plan for the proposed transaction.

28. Market Studies: Attach as Appendix X each market study (and attachments) done for or by a nonprofit, or otherwise received by a nonprofit. Include an analysis of the nonprofit's market share from the perspectives which are normally tracked by the nonprofit board.

29. Registered Agents for Service or Process: Identify the registered agent for service of process, including his or her complete address, for each nonprofit and for the acquirer.

For Nonprofit:

_______________________________________________

For Acquirer:

_______________________________________________

30. Litigation and Proceedings: Attach as Appendix Y copies of any and all complaints, pleadings, memoranda, court orders, settlements, liens or other security interests, and consent decrees filed in litigation in which the nonprofit and/or acquirer was or is a party.

Please include in your response any and all complaints, pleadings, memoranda, orders, settlements, opinions, notices of investigation (including subpoenas, civil investigative demands or other requests for information), of any state, federal, local government department, court, agency, or any other legal proceeding in which the nonprofit and/or acquirer was or is a party.

CERTIFICATION AND VERIFICATION

AFFIDAVIT OF THE NONPROFIT

To be completed by President or Chief Officer

This Requests for Information Form, together with any and all appendices and attachments thereto, was prepared and assembled under my supervision in accordance with the instructions and definitions issued by the Attorney General. Subject to the recognition that, where so indicated, reasonable estimates have been made because books and records do not provide the required data, the information is, to the best of my knowledge, true, correct, and complete. If copies were submitted in lieu of originals, the documents submitted are true and exact copies. I understand that my obligation to provide information pursuant to this Request shall be continuing in nature and shall forthwith notify the Attorney General, in writing, of any representations that have been made or that might have been made in accordance with this Request which need to be updated, corrected or modified. The copies also are authentic for the purposes of Louisiana law. If copies were submitted, I also agree to retain the originals under may care, custody, and control, and I will not destroy or alter the originals without express written consent of the Attorney General or his appointed designee.

I certify, upon personal knowledge, that the attached form has been completed with true and accurate information, under penalty or perjury.

STATE of ______________________________ To be completed by Affiant:

Parish/County:)_____________________

Affiant's Name: ________________________________

Signature: Title:

Date: ______________________________________ Address:

Sworn and subscribed before me

this ____ day of _________, ___________________

199 _____ _____________

Telephone No.: ______________________

Notary Public Facsimile No.: ____________________

My Commission expires: ________

AFFIDAVIT OF OFFICERS AND DIRECTORS

STATE OF _________ SOCIAL SECURITY NO.

PARISH/COUNTY OF __________

I, ____________________________, after first being duly sworn, do hereby depose and, upon personal knowledge, state as follows:

1. I am an officer/director (please circle appropriate response) of _______________________ (insert name of nonprofit).

2. I have been an officer/director (please circle appropriate response) since ______, 199 . Please identify any committees you have served on, the length of service on each committee, and any titles you have held on such committees.

_______________________________________________

3. My home address is ___________________________________

_______________________________________________

4. My business telephone number is ________________ . My business facsimile number is.

5. I do/do not (circle appropriate response) own stock or options and/or warrants to purchase stock in __________ (Insert name of acquirer) or any parent, subsidiary, or affiliated company.

6. ___________ (insert "no one in my immediate family," or the name[s] of family member[s], own(s) stock or options and/or warrants to purchase stock in ____________(insert name of acquirer) or any parent, subsidiary, or affiliated company.

7. I am/am not (circle appropriate response) employed by __________ (insert name of acquirer) or any parent, subsidiary, or affiliate company.

8. ___________(insert " no one in my immediate family" or the name[s] of family member[s] is/are employed by ___________(insert name of acquirer) or any parent, subsidiary, or affiliated company.

9. I will/will not (circle correct response) receive any financial benefit from the sale/merger (circle correct response) of ______________ (identify nonprofit to be acquired) to ________________________ (insert name of acquirer).

10. ___________(insert "no one in my immediate family," or the name[s] of family member[s] will receive any financial benefit from the sale/merger (circle correct response) of ________________________ (identify nonprofit to be acquired) ________________________ (insert name of acquirer).

11. I have/have not (circle appropriate response) been contacted or otherwise requested or been offered a position on the ______________________ (insert name of acquirer) board or any of its subsidiaries, affiliates, or parent companies, or otherwise been offered employment of any sort with __ (insert name of acquirer) or any of its subsidiaries, affiliates or parent companies.

12. I am/am not compensated for my services as an officer/director (circle appropriate response) of ____________ (insert name of nonprofit). If your response is that you are compensated, please state the amount of your compensation per year: ___________.

13. Briefly describe your education background:

_______________________________________________

14. Briefly describe your business or work experience:

_______________________________________________

15. Explain the reasons why you voted to approve the transaction to merge/sell _______ (insert nonprofit's name) to __________ (insert name of acquirer).

_______________________________________________

16. Please briefly explain any information you had regarding valuation of (insert nonprofit's name) and other options available to (insert nonprofit's name) prior to approving the transaction referenced in Item 15.

_______________________________________________

17. I do/do not (circle appropriate response) plan to become a director or officer of the foundation or other nonprofit entity to be created from the assets resulting from the sale or merger of ____________ (insert nonprofit's name) to _________ (insert name of acquirer). I will/will not (circle appropriate response) receive compensation for my service in such position. If your response is that you will be compensated, please state the amount of the compensation per year: ________________

18. I do/do not (circle appropriate response) have any conflict of interest, self-interest, financial interest or other self-dealing with regard to the proposed transaction with ____________ (insert name of acquirer). If your answer is yes, please explain such interest in detail.

I certify, upon personal knowledge, that the information in this affidavit is true, accurate, and complete, under penalty of perjury.

Affiant's

Signature: _______________

Date: __________

Sworn and subscribed

before me this ________

day of _______________,

199 _________

Notary Public

My Commission expires: ________

CERTIFICATION AND VERIFICATION

AFFIDAVIT OF THE ACQUIRER

In order to assist ____________________ (insert name of nonprofit), (insert name of acquirer) provided information used to complete the Request for Information Form by _____________________ (insert name of nonprofit). Attached as Exhibit A to this Affidavit are ______________________ 's (insert name of acquirer) responses to the Request for Information Form, together with any and all appendices and attachments thereto. Exhibit A was prepared and assembled under my supervision in accordance with the instructions and definitions and definitions issued by the Attorney General. Subject to the recognition that, where so indicated, reasonable estimates have been made because books and records do not provide the required data, the information is, to the best of my knowledge, true, correct, and complete. If copies were submitted in lieu of originals, the documents submitted are true and exact copies. I understand that my obligation to provide information pursuant to this Request shall be continuing in nature and shall forthwith notify the Attorney General, in writing, of any representations that have been or that might have been made in accordance with this Request which need to be updated, corrected or modified. The copies also are authentic for the purpose of Louisiana law. If copies were submitted, I also agree to retain the originals under my care, custody, and control, and I will not destroy or alter the originals without the express written consent of the Attorney General or his appointed designee.

I certify, upon personal knowledge, that the attached form has been completed with true and accurate information, under penalty of perjury.

STATE of ______________________________ To be completed by Affiant:

Parish/County: _________________

Affiant's Name: ________________________________

Signature: __________ Title: ___________

Date: ________________ Address:

Sworn and subscribed before me _________________

this ____ day of ___________, __________________

199________ ____________

Telephone No.: ______________________

Notary Public Facsimile No.: ________________

My Commission expires: ________

LOUISIANA ATTORNEY GENERAL'S

REQUEST FOR INFORMATION FORM FOR CERTAIN

NONPROFIT MERGERS, SALES, AND ACQUISITIONS

INSTRUCTIONS AND DEFINITIONS

1. All responses to the Request for Information Form must be typed or clearly printed in black ink. You must use only the official forms.

2. All documents and appendices must be provided in compliance with the following:

(a) one set of original documents and three (3) separate sets of legible and collated copies of all documents must be submitted;

(b) each appendix shall be submitted in a separate legal size folder clearly marked with the appendix number along with the name of your nonprofit entity and the date of the Attorney General's Request for Information, set forth in Instruction #9. For example, Nonprofit Company X, Appendix A, July 1, 1996; and

(c) each document must be consecutively numbered and labeled along with an abbreviation for your nonprofit entity. For example, the first document of a submission by the Nonprofit Company X, would be labeled NCX0001. These initials and numbers should appear in the lower right-hand corner or each document.

3. All amendments or late-filed documents or responses must be clearly labeled to indicate which Request or appendix folder the document should be placed in upon receipt by the State. Such documents must be submitted in compliance with all other instructions herein.

4. Unless otherwise indicated, documents to be produced pursuant to this Request for Information Form include each and every document prepared, sent, dated, received, in effect, or which otherwise came into existence during the last three (3) years through the date of the production of documents by the nonprofit pursuant to this Request. Responses to the Request must be supplemented, corrected, and updated until the close of the transaction. The Attorney General, at his discretion, may require the production of additional documents.

5. For each Request calling for the production of documents, produce each and every responsive document in the nonprofit and/or acquiring entity's care, possession, custody, or control, without regard to the physical location of those documents.

6. If the nonprofit and/or acquiring entity possesses no documents responsive to a paragraph of this Request, the nonprofit and/or acquirer must state this fact, specifying the paragraph(s) or subparagraph(s) concerned, in the response. If the nonprofit and/or acquirer must submit documents at a later date than that set forth in Instruction #9, the following procedure is required: the nonprofit and/or acquirer must state this fact, specify the paragraph(s) or subparagraph(s) concerned, identify the document(s) to be produced, and state the expected date of production.

7. If the nonprofit and/or entity asserts a privilege in response to a Request, the nonprofit and/or acquiring entity must state the priviledge, the basis of the priviledge, and identify the documents and Request to which the priviledge attaches.

8. Responses to Requests not requiring the production of documents should be typed or clearly printed in black on the Request for Information Form. If additional space is required, you should attach additional 8 1/2" x 11" size pages, clearly noting at the top of the page to which Request the additional information is responsive and the identity of the nonprofit providing the information. For example: Nonprofit Company X, Continuation to Request #3.

9. This Request for Information is dated ___________ . The Attorney General must receive a complete response to this initial Request for Information Form, no later than _________ 199 . If you are unable to provide the information by the date set forth above, please contact, _____________, Assistant Attorney General, at __________ within twenty-four (24) hours to discuss an extension of the statutory fifteen (15) day period in order to extend the time period for you to respond to this Request. If you request an extension of the time period, you will be provided an Extension of the fifteen (15) Day Period Form, via facsimile transmission, which must be returned within twenty-four (24) hours of your discussion with the Assistant Attorney General or paralegal in order to extend the response period for the Request for Information. All extensions are subject to the final approval of the Attorney General.

10. All responses to this Request for Information shall be sent by United States Mail, hand delivered, or a nationally recognized express delivery service to the following individual.

Assistant Attorney General

11. The Request for Information Form is not complete or valid without the Certification and Verification Affidavits executed under oath in the presence of a notary and attached to the Request for Information Form.

12. Copies may be submitted in lieu of originals as long as the nonprofit and/or acquirer indicate(s) that the documents are copies, the location of the originals, and the reason for the substitution of copies. All originals must be returned as set forth in the Certification and Verification Affidavits. Additionally, the nonprofit and/or acquirer must sign the Certification of Verification Affidavit(s), agreeing that the documents are authentic for the purposes of Louisiana law.

13. All questions regarding these forms, the scope of any Request, and instruction, or any definitions shall be directed to the Assistant Attorney General listed in Instruction #10.

14. This Request for Information Packet should include all of the following forms:

Form : Instructions and Definitions

Form : Request for Information Form

Form : Certification and Verification Affidavit of the Nonprofit Affidavit of Officers and Directors

Certification and Verification Affidavit of the Acquirer Extension of the fifteen (15) Day Period

If your packet is missing any of the above listed forms, please contact by telephone the Assistant Attorney General listed in Instruction #10 immediately. Your response to the Request for Information Form is not complete until the Attorney General's Office has received all of the above listed forms, fully completed.

15. In the lower right-hand corner of each page of the Request for Information Form, type or print the name of the nonprofit in the space provided.

16. If two (2) or more nonprofits are merging, each nonprofit must complete the entire Request for Information Packet.

EXTENSION OF THE FIFTEEN (15) DAY

PERIOD FORM FOR CERTAIN NONPROFITS

On behalf of _________ (insert name of nonprofit., I, ________________ (insert your name), hereby waive any right (insert name of nonprofit) may have for the Attorney General to review the proposed application transaction between _____________(insert name of acquirer) within a fifteen (15) day period. On behalf of ____________________ (insert name of nonprofit), I hereby agree and consent to an extension of the fifteen (15) day period within which the Louisiana Attorney General's Office may review the transaction. Specifically, I agree that the fifteen (15) day period will be extended an additional ________ (insert number) days Thus, the Attorney General's right to review ________________ 's (insert name of nonprofit) proposed transaction application shall not conclude before ____________, 199 . (insert date extension will conclude).________ (insert name of nonprofit) hereby agrees not to conclude or finalize the transaction until after _________, 199.

(insert day after extension will conclude). I further agree to submit all documents requested by the Attorney General in the Request for Information Packet no later than ________, 199.

The reason for this request is as follows: ________________________

_______________________________________________

On behalf of _________ (insert name of nonprofit), I, ___________ (insert your name), represent and warrant that I have authority to act for and bind ________________ (insert name of nonprofit).

I also understand that this Request for an Extension is subject to the final approval of the Attorney General. I certify, that this extension form has been completed with true and information, under penalty of perjury.

STATE of ________________________ To be completed by Affiant:

County of __________________________

Affiant's Name: ________________________________

Signature: ______________ Title: ___________

Date: ______________________________________ Address:

Sworn and subscribed before me _______________

this ____ day of ___________, ___________

199_________ ________________

Phone No.: ____________________

Notary Public Facsimile No.: ___________________

My Commission expires: _______

C. Filing of Additional Documents

1. Format required for filing of additional documents shall be in accord with §307. A 9

2. Documents relating to an application shall be filed by delivering an original and three copies to the director.

3. Additional documents to an application may be accepted by facsimile machine provided that the original and three copies thereof are received by the director no later than seven days after transmission of the facsimile.

La. Admin. Code tit. 48, § XXV-307

Promulgated by the Department of Justice, Office of the Attorney General, LR 24:1130 (June 1998).

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:2115.11 et seq.