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Notice Of Transaction Pursuant To Corporations Code Section 25102(f) DBO-25102 F - California

Notice Of Transaction Pursuant To Corporations Code Section 25102(f) Form. This is a California form and can be used in Securities Regulation Division Blue Sky Secretary Of State .
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STATE OF CALIFORNIA ­DEPARTMENT OF BUSINESS OVERSIGHT DBO ­ 260.102.14 (c) (Register 2009, No.39) (Rev. 07-13) (Department of Business Oversight Use Only) NOTICE OF TRANSACTION PURSUANT TO CORPORATIONS CODE SECTION 25102(f) DEPARTMENT OF BUSINESS OVERSIGHT FILE NO., if any: Fee paid $ Receipt No. Insert File number(s) of Previous Filings Before the Department, if any. Fee: $25.00 $35.00 $50.00 $150.00 $300.00 (Circle the appropriate amount of fee. See Corporations Code Section 25608(c)) A. Check one: Transaction under ( ) Section 25102(f) ( ) Rule 260.103. ELECTRONIC FILING REQUIREMENT AND HARDSHIP EXCEPTION: This notice must be filed electronically through the Internet process made available by the Department of Corporations at www.dbo.ca.gov, unless the issuer claims the hardship exception as described in Number 8 below. 1. Name of Issuer: 2. Address of Issuer: Street Mailing Address: Street 3. Area Code and Telephone Number: 4. Issuer's state (or other jurisdiction) of incorporation or organization: City State Zip City State Zip 5. Title of class or classes of securities sold in transaction: 6. The value of the securities sold or proposed to be sold in the transaction, determined in accordance with Corporations Code Sec. 25608(g) in connection with the fee required upon filing this notice, is (fee based on amount shown in line (iii) under "Total Offering"): California (a)(i) in money $ (ii) in consideration other than money $ (iii) total of (i) and (ii) $ (b) ( ) Change in rights, preferences, privileges or restrictions of or on outstanding ($25.00 fee.) (See Rule 260.103.) 7. Type of filing under Securities Act of 1933, if applicable: DBO ­ 260.102.14 (c) (Register 2009, No.39)(Rev. 07-13) Total Offering $ $ $ securities 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 8. Hardship Exception for electronic filing. An issuer may file this paper notice in person or by mail only if either of the following exceptions apply. The issuer shall check applicable box and include the reason(s) and description(s) for the hardship exception in the space provided. Computer equipment including hardware and software is unavailable to the issuer without unreasonable burden or expense. If this is the case, describe below both of the following; the reason(s) that the computer equipment including hardware and software is unavailable without unreasonable burden or expense, and the description(s) of the unreasonable burden or expense. The issuer cannot obtain and provide information (including credit card or other identifying information) requested on the Department's electronic notice or through the Internet filing process. If this is the case, describe below both of the following: the reason(s) that the issuer cannot obtain and provide the requested information on the electronic notice or through the Internet filing process without unreasonable burden or expense, and the description(s) of the unreasonable burden or expense to the issuer to make the electronic filing. After checking the applicable hardship exception above, the issuer shall describe below the reason(s) and description(s) for that hardship exception. (If additional space is needed, attach a separate sheet to this notice.) 9. ( ) Check if issuer already has a Consent to Service of process on file with the Commissioner. (Instruction: Each issuer (other than a California Corporation) filing a notice under Section 25102(f) must file a consent to service of process (Form 260.165), unless it already has a consent to service on file with the Commissioner. If no consent to service of process is on file with the Commissioner, attach the consent to this notice.) 10. Authorized Signature on behalf of issuer Print name and title of signatory Date Name, Address and Phone number of contact person: DBO ­ 260.102.14 (c) (Register 2009, No.39)(Rev. 07-13) 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com
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