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Notice Of Exempt Securities Transactions Under AS 45.55.900(b)(19) 08-111 - Alaska
| Notice Of Exempt Securities Transactions Under AS 45.55.900(b)(19) Form. This is a Alaska form and can be used in General Blue Sky Secretary Of State . |
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Notice of Exempt Securities Transactions Under AS 45.55.900(b)(19) (To be filed along with the required fee described at 3 AAC 08.920(6) ) Please fill out this form and submit to: Administrator of Securities Alaska Division of Banking, Securities, and Corporations P.O. Box 110807 Juneau, AK 99811-0807 (907) 465-2521 STATUTORY REFERENCE AS 45.55.900(b) The following transactions are exempted from AS 45. 55.070 and 45.55.075: (19) an offer to repay, under AS 45.55.930, the buyer of a security i f the offeror first files with the administrator a notice specifying the terms of the offer at least two da ys before the offer is made; REMEMBER TO FILE Form 08-111A WHEN THE RESCISSION OFFER HAS BEEN COMPLETED. 1. Name, Address and Telephone number of person requesting the use of this exemption: Full Name of contact person Address Phone Fax The person signing this form must show name & address above. If for som e reasons that person is not available to sign, please request a waiver in writing and give reason.. 2. Name, Address, and Telephone number of Issuer: Issuer Name Address Phone 3. Please provide a brief description of the security which was sold w ithout registration or exemption from registration (describe security, price, and inte rest, if any): 4. Date rescission offer will commence: (may not be sooner than 2 days after the filing date of this exemption notice or as determined by the administrator). 5. Describe any special considerations you ask the administrator to c onsider, including any requests for waiver of any limitations of the exemption. Waiver requests must in clude full disclosure to the administrator of the facts and relevant material factors relating to the request. American LegalNet, Inc.08-111 (rev. 02/02) www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 6. Describe where the mone y to repay purchasers will come from and whether it will be sufficient t o meet the rescission and leave the entity able to carry on its business: Additional information (Please refer to number being further expla ined): ATTACH A COPY OF THE RESCISSION OFFER (AS 45.55.900(b)(19) AND ALL DISCLOSURES PROVIDED UNDER 3 AAC 08.915. INCLUDE A LIST OF THE NAMES, ADDRESSES OF THE PER SONS BEING OFFERED RESCISSION AND DOLLAR AMOUNTS OF THE SECURITIES INVOLVED. BE SURE TO FILE FORM 08-111A WHEN THE OFFER OF RE SCISSION HAS BEEN CO MPLETED By filing this notice, I affirm that all statutory requirements of AS 45 .55.900(b)(19) and 3 AAC 08.915 have been met to date and will continue to be met during the offering pe riod. Signature of attorney or principal (please describe which) Title Date E-mail address (to receive notice of effectiveness): American LegalNet, Inc.08-111 (rev. 02/02) www.USCourtForms.com
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