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Post Sale Registration Certification By Business Opportunity Seller - Connecticut

Post Sale Registration Certification By Business Opportunity Seller Form. This is a Connecticut form and can be used in Securities Blue Sky Secretary Of State .
 Fillable pdf Last Modified 9/27/2005
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POST-SALE REGISTRATION CERTIFICATION BY BUSINESS OPPORTUNITY SELLER The undersigned seller of business opportunities, having applied forpost-sale registration under Section 36b-62(e) of the Connecticut BusinessOpportunity Investment Act, certifies to the Connecticut Banking Commissioner as follows: 1. Each purchaser-investor to whom an unregistered business opportunity was sold has signed the post-sale registration document consisting of an Explanatory Statement and Statement of Non-prejudice; and 2. Included herewith are the signed documents referenced above and their return receipts; and 3. Attached hereto as "Exhibit A" is a list of the names, addresses and telephone numbers of those purchaser-investors to whom business opportunities have been sold without compliance with the registration provisions of sections 36b-60 to 36b-80, inclusive, and the amount of payment furnished by each purchaser-investor for the business opportunity. Print Name of Business Opportunity Seller: __________________________ Signature of Executive Officer or Authorized Person of Similar Rank: __________________________ Print Name of Signatory: __________________________ Date: __________________________Revised 0020/1/5 <<<<<<<<<********>>>>>>>>>>>>> 2 EXHIBIT A: LIST OF PURCHASER-INVESTORS (Use Additional Sheets if Necessary) Prepared Pursuant to Section 36b-62(e)(3) of the Connecticut Business Opportunity Investment Act NAME ADDRESS TELEPHONE PAYMENT NUMBER AMOUNT
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