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Application For A License Under The Capital Access Company Law CACL 280.151 - California

Application For A License Under The Capital Access Company Law Form. This is a California form and can be used in Capital Access Law Blue Sky Secretary Of State .
 Fillable pdf Last Modified 12/9/2013
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STATE OF CALIFORNIA ­DEPARTMENT OF BUSINESS OVERSIGHT DBO ­ CACL 280.151 (Rev. 08-13) (Department of Business Oversight Use Only) Fee Paid $ ___________________ Receipt No. __________________ APPLICATION FOR LICENSE UNDER THE CAPITAL ACCESS COMPANY LAW DEPARTMENT OF BUSINESS OVERSIGHT File No.__________________________ PRE-LICENSE AMENDMENT NO. _________________ POST-LICENSE AMENDMENT NO. ________________ The application must be TYPEWRITTEN and accompanied by an application fee of $1,400. The application (together with the fee payable to the Commissioner of Business Oversight must be filed only in the Sacramento Office of the Department of Business Oversight. Special Instructions: Any amendment to this application for licensure under the Capital Access Company Law shall be made by a verified pre-license or post-license amendment to the application. A pre-license amendment is required for an amendment to the application prior to licensure; a post-license amendment is required subsequent to licensure. An amendment is made by filing the completed "Facing Page" with the appropriate pre-license or post-license amendment number entered, attaching the pages of that part of the application (including the exhibits) that are revised or changed, and attaching another duly executed and verified "Execution Page". (The Execution Page is found at the end of this application.) 1. Name of Applicant: ________________________________________________________ Fictitious Business Name: __________________________________________________ 2. List the place or places of business at which Applicant will engage in licensed activity. Indicate principal place of business and branch or other office locations: (Attach a separate sheet, if necessary.) (Number and Street) (City) (County) (State) (Zip) ___________________________________________________________________________ _____________________________________ ("d.b.a." or fictitious business name) ___________________________________ (Name of person in charge of business location) 3. Applicant is organized and will do business as (check as applicable): [ ] a corporation [ ] a partnership [ ] trust [ ] a limited liability company [ ] a limited partnership [ ] other (please specify) _______________________ [The application continues on the following, separate pages.] 4. Complete the following: Applicant was organized on ___________________________________. (Date) American LegalNet, Inc. www.FormsWorkFlow.com STATE OF CALIFORNIA ­DEPARTMENT OF BUSINESS OVERSIGHT DBO ­ CACL 280.151 (Rev. 08-13) Page 2 of 11 APPLICATION FOR LICENSE UNDER THE CAPITAL ACCESS COMPANY LAW The FULL first, middle (if no middle name, so indicate) and last name, and complete business address MUST be given for each person named below: (Attach additional sheets, if necessary.) General Partners: _____________________________________________________________________________ (Name) (Business Address) _____________________________________________________________________________ (Name) (Business Address) ___________________________________________________________________________ (Name) (Business Address) President/Chief Executive Officer: ___________________________________________________________________________ (Name) (Business Address) Executive Vice President/Vice President: ___________________________________________________________________________ (Name) (Business Address) Secretary: ___________________________________________________________________________ (Name) (Business Address) Treasurer/Chief Financial Officer: ___________________________________________________________________________ (Name) (Business Address) Other Principal Officers: ___________________________________________________________________________ (Name and Title) (Business Address) ___________________________________________________________________________ (Name and Title) (Business Address) ___________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com STATE OF CALIFORNIA ­DEPARTMENT OF BUSINESS OVERSIGHT DBO ­ CACL 280.151 (Rev. 08-13) Page 3 of 11 Director(s): APPLICATION FOR LICENSE UNDER THE CAPITAL ACCESS COMPANY LAW ___________________________________________________________________________ (Name) (Business Address) ___________________________________________________________________________ (Name) (Business Address) ___________________________________________________________________________ (Name) (Business Address) Manager(s)/Member(s) [i.e., a manager member of an association, or a manager appointed or elected by the members of a limited liability company]: ___________________________________________________________________________ (Name) (Business Address) ___________________________________________________________________________ (Name) (Business Address) ___________________________________________________________________________ (Name) (Business Address) Trustee(s): ___________________________________________________________________________ (Name) (Business Address) ___________________________________________________________________________ (Name) (Business Address) ___________________________________________________________________________ (Name) (Business Address) Employees who have access to or responsibility for funds held by the applicant: ___________________________________________________________________________ (Name and Title) (Business Address) ___________________________________________________________________________ (Name and Title) (Business Address) ___________________________________________________________________________ (Name and Title) (Business Address) American LegalNet, Inc. www.FormsWorkFlow.com STATE OF CALIFORNIA ­DEPARTMENT OF BUSINESS OVERSIGHT DBO ­ CACL 280.151 (Rev. 08-13) Page 4 of 11 APPLICATION FOR LICENSE UNDER THE CAPITAL ACCESS COMPANY LAW Any person (other than those persons listed above) that owns or controls, directly or indirectly, the power to direct, or cause the direction of, the management and policies of the applicant. If the "person" is a corporation or other business entity, please provide sufficient information to identify the individual(s) in positions of management in, or who own or control, the corporation or business entity. (E.g., the name and business address of the officers, directors, partners, etc.) (See Corporations Code Sections 28035 and 28036): ________________________________________
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