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Notice Of Sale Of Securities 703 - Mississippi
| Notice Of Sale Of Securities Form. This is a Mississippi form and can be used in Securities Blue Sky Secretary Of State . |
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Notice of Sale of Securities Pursuant To Rule 703 Notice of Sale of Securities pursuant to Rule 703, Section 75-71-203, Mississippi Code of 1972, as amended, Exemption from Registration for Certain Offerings By Domestic Issuers General Instructions Who May File: Any issuer under the laws of the State of Mississippi and making an offering of securities in reliance upon the exemption provided in Rule 703, Section 75-71-203, Mississippi Code 1972, as amended. A notice must be filed before the first sale of securities in the offering. A notice must be filed with the Secretary of State's Office, Securities and Charities Division. Physical address: Mississippi Secretary of State's Office Securities and Charities Division 700 North Street Jackson, Mississippi 39202 Mailing address: Mississippi Secretary of State's Office Securities and Charities Division Post Office Box 136 Jackson, Mississippi 39205-0136 Required Forms and Fees Additional Information: Completed and manually signed Notice of Sale of Securities Pursuant to Rule 703 form and filing fee of $300.00. When To File: Where To File: Additional information may be required. If required, the information will be requested from the filer. NOTICE The Notice of Sale of Securities pursuant to Rule 703 does not relieve the issuer of its obligation to provide the investor full, meaningful disclosure as required under the Mississippi Securities Act and the Rules promulgated thereunder. Page 1 of 12 Form 703 Rev. 1/2010 American LegalNet, Inc. www.FormsWorkFlow.com NOTICE Mississippi Secretary of State Notice of Sale of Securities Pursuant To Rule 703 Notice of Sale of Securities pursuant to Rule 703, Section 75-71-203, Mississippi Code of 1972, as amended, Exemption from Registration for Certain Offerings By Domestic Issuers A. General Information 1. Name of Offering: 2. Name of Issuer: 3. Address of Principal Office of Issuer (Include number and street, city, state and zip code of physical location): 4. Telephone Number for Principle Office of Issuer: 5. Fax Number for Principle Office of Issuer: 6. Name, Address, Telephone Number, Fax Number and Email Address of Correspondent to whom Notices may be sent: Page 2 of 12 Form 703 Rev. 1/2010 American LegalNet, Inc. www.FormsWorkFlow.com 7. Type of Business Organization and Date of Organization: _____ Corporation _____ Limited Partnership _____ Other Date Organized: ____________________________ Date Organized: ____________________________ Date Organized: ____________________________ (Please specify: ______________________________________________) 8. Description of business for which the securities are issued: Page 3 of 12 Form 703 Rev. 1/2010 American LegalNet, Inc. www.FormsWorkFlow.com B. Basic Identification Data 9. Enter the requested information for the following: · · · · Each promoter of the issuer, if the issuer has been organized within the past five years; Each beneficial owner having the power to vote or dispose, or direct the vote of disposition of, 10% or more of a class of equity securities of the issuer; Each executive officer and director of corporate issues and of corporate general and managing partners of partnership issuer; and Each general and managing partner of partnership issuers (a) Check all that apply: Promoter Beneficial Owner Executive Director Full Name: Address: City, State Zip: Director General and/or Managing Partner (b) Check all that apply: Promoter Beneficial Owner Executive Director Full Name: Address: City, State Zip: Director General and/or Managing Partner Page 4 of 12 Form 703 Rev. 1/2010 American LegalNet, Inc. www.FormsWorkFlow.com (c) Check all that apply: Promoter Beneficial Owner Executive Director Full Name: Address: City, State Zip: (d) Check all that apply: Director General and/or Managing Partner Promoter Beneficial Owner Executive Director Full Name: Address: City, State Zip: (e) Check all that apply: Director General and/or Managing Partner Promoter Beneficial Owner Executive Director Full Name: Address: City, State Zip: Director General and/or Managing Partner Page 5 of 12 Form 703 Rev. 1/2010 American LegalNet, Inc. www.FormsWorkFlow.com C. Information about Offering 10. Describe the securities to be offered. 11. What is the minimum investment that will be accepted from any individual? 12. Enter information concerning the payment of any commission or similar remuneration for the solicitation of purchasers in connection with sales of securities in the offering. (NOTE: Commissions for Rule 703 Offerings are not permitted unless approved by the Mississippi Secretary of State.) (a) State commission per unit in dollar amount as a percentage of unit purchase price: (b) State commission for total offering in dollar amount and as a percentage of total offering proceeds: (c) List name and address of person(s) to whom commissions or other remuneration for sales will be paid: Page 6 of 12 Form 703 Rev. 1/2010 American LegalNet, Inc. www.FormsWorkFlow.com 13. Did the issuer sell any securities in Mississippi during the twelve (12) months preceding the date of the filing? If so, describe the securities and indicate the number of purchasers and the dollar amount sold to each purchaser. Page 7 of 12 Form 703 Rev. 1/2010 American LegalNet, Inc. www.FormsWorkFlow.com D. Offering Price, Number of Investors, Expenses and Use of Proceeds 14. Enter the aggregate offering price of securities included in this offering. Type of Security Debt Aggregate Offering Price $ __________________________________ Equity $ __________________________________ Common Convertible securities (including warrants) Preferred $ __________________________________ Partnership interests $ __________________________________ Other $ __________________________________ (specify___________________________) TOTAL $ __________________________________ Page 8 of 12 Form 703 Rev. 1/2010 American LegalNet, Inc. www.FormsWorkFlow.com 15. Furnish a statement of all expenses in connection with the issuance and distribution of the securities in this offering. If the amount of an expenditure is not known, furnish an estimate and check the box to the left of the estimate. Printing cost $ __________________________________ Legal Fees $ __________________________________ Accounting Fees $ __________________________________ Engineering Fees $ __________________________________ Sales Commissions $ __________________________________ $ __________________________________ Other Expenses
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