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Form D Notice Of Sale Of Securities Pursuant To Regulation D Section 4(6) (SEC1972) D - Official Federal Forms
| Form D Notice Of Sale Of Securities Pursuant To Regulation D Section 4(6) (SEC1972) Form. This is a national form and can be used in Securities And Exchange Commission . |
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You may not send a completed printout of this form to the SEC to satisfy a filing obligation. You can only satisfy an SEC filing obligation by submitting the information required by this form to the SEC in electronic format online at https://www.onlineforms.edgarfiling.sec.gov. FORM D Notice of Exempt Offering of Securities U.S. Securities and Exchange Commission Washington, DC 20549 OMB APPROVA OMB APPROVAL L OMB Number: 3235-0076 Expires: August 31, 2015 (See instructions beginning on page 5) Intentional misstatements or omissions of fact constitute federal criminal violations. See 18 U.S.C. 1001. Estimated average burden Item 1. Issuer's Identity Name of Issuer Previous Name(s) None hours per response: 4.00 Entity Type (Select one) Corporation Limited Partnership Limited Liability Company General Partnership Business Trust Other (Specify) Jurisdiction of Incorporation/Organization Year of Incorporation/Organization (Select one) Over Five Years Ago Within Last Five Years (specify year) Yet to Be Formed (If more than one issuer is filing this notice, check this box Street Address 1 and identify additional issuer(s) by attaching Items 1 and 2 Continuation Page(s).) Street Address 2 Item 2. Principal Place of Business and Contact Information City State/Province/Country ZIP/Postal Code Phone No. Item 3. Related Persons Last Name First Name Street Address 2 Middle Name Street Address 1 City State/Province/Country ZIP/Postal Code Relationship(s): Executive Officer Director Promoter Clarification of Response (if necessary) (Identify additional related persons by checking this box and attaching Item 3 Continuation Page(s). ) Construction REITS & Finance Residential Other Real Estate Item 4. Industry Group (Select one) Business Services Energy Electric Utilities Energy Conservation Coal Mining Environmental Services Oil & Gas Other Energy Agriculture Banking and Financial Services Commercial Banking Insurance Investing Investment Banking Pooled Investment Fund If selecting this industry group, also select one fund type below and answer the question below: Hedge Fund Private Equity Fund Venture Capital Fund Other Investment Fund Is the issuer registered as an investment company under the Investment Company Yes No Act of 1940? Other Banking & Financial Services Retailing Restaurants Technology Computers Telecommunications Other Technology Health Care Biotechnology Health Insurance Hospitals & Physicians Pharmaceuticals Other Health Care Travel Airlines & Airports Tourism & Travel Services Other Travel Lodging & Conventions Manufacturing Real Estate Commercial Other American LegalNet, Inc. www.FormsWorkFlow.com SEC1972 (02/12) Form D 1 FORM D Item 5. Issuer Size U.S. Securities and Exchange Commission Washington, DC 20549 (Select one) Aggregate Net Asset Value Range (for issuer specifying "hedge" or "other investment" fund in Item 4 above) No Aggregate Net Asset Value $1 - $5,000,000 $5,000,001 - $25,000,000 $25,000,001 - $50,000,000 $50,000,001 - $100,000,000 Over $100,000,000 Decline to Disclose Not Applicable Revenue Range (for issuer not specifying "hedge" or "other investment" fund in Item 4 above) No Revenues $1 - $1,000,000 $1,000,001 - $5,000,000 $5,000,001 - $25,000,000 $25,000,001 - $100,000,000 Over $100,000,000 Decline to Disclose Not Applicable OR Item 6. Federal Exemptions and Exclusions Claimed Rule 504(b)(1) (not (i), (ii) or (iii)) Rule 504(b)(1)(i) Rule 504(b)(1)(ii) Rule 504(b)(1)(iii) Rule 505 Rule 506 Securities Act Section 4(5) (Select all that apply) Section 3(c)(9) Section 3(c)(10) Section 3(c)(11) Section 3(c)(12) Section 3(c)(13) Section 3(c)(14) Investment Company Act Section 3(c) Section 3(c)(1) Section 3(c)(2) Section 3(c)(3) Section 3(c)(4) Section 3(c)(5) Section 3(c)(6) Section 3(c)(7) Item 7. Type of Filing New Notice OR Amendment Date of First Sale in this Offering: OR First Sale Yet to Occur Item 8. Duration of Offering Does the issuer intend this offering to last more than one year? Yes No Item 9. Type(s) of Securities Offered Equity Debt Option, Warrant or Other Right to Acquire Another Security (Select all that apply) Pooled Investment Fund Interests Tenant-in-Common Securities Mineral Property Securities Other (describe) Security to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire Security Item 10. Business Combination Transaction Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer? Clarification of Response (if necessary) Yes No American LegalNet, Inc. www.FormsWorkFlow.com Form D 2 FORM D U.S. Securities and Exchange Commission Washington, DC 20549 Item 11. Minimum Investment Minimum investment accepted from any outside investor $ Item 12. Sales Compensation Recipient Recipient CRD Number No CRD Number (Associated) Broker or Dealer None (Associated) Broker or Dealer CRD Number No CRD Number Street Address 1 Street Address 2 City States of Solicitation State/Province/Country ZIP/Postal Code All States AZ IA NV SD AR KS NH TN CA KY NJ TX CO LA NM UT CT ME NY VT DE MD NC VA DC MA ND WA FL MI OH WV GA MN OK WI HI MS OR WY ID MO PA PR AL IL MT RI AK IN NE SC (Identify additional person(s) being paid compensation by checking this box and attaching Item 12 Continuation Page(s).) Item 13. Offering and Sales Amounts (a) Total Offering Amount (b) Total Amount Sold (c) Total Remaining to be Sold (Subtract (a) from (b)) $ $ $ OR Indefinite OR Indefinite Clarification of Response (if necessary) Item 14. Investors Check this box if securities in the offering have been or may be sold to persons who do not qualify as accredited investors, and enter the number of such non-accredited investors who already have invested in the offering: Enter the total number of investors who already have invested in the offering: Item 15. Sales Commissions and Finders' Fees Expenses Provide separately the amounts of sales commissions and finders' fees expenses, if any. If an amount is not known, provide an estimate and check the box next to the amount. Sales Commissions $ Clarification of Response (if necessary) Finders' Fees $ Estimate Estimate Form D 3 American LegalNet, Inc. www.FormsWorkFlow.com FORM D U.S. Securities and Exchange Commission Washington, DC 20549 Item 16. Use of Proceeds Provide the amount of the gross proceeds of the offering that has been or is proposed to be used for payments to any of the persons required to be named as executive officers, directors or pro
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