Florida > Secretary Of State > Blue Sky > Securities Offerings-Registration
Notification Registration OFR-S-3-91 - Florida
| Notification Registration Form. This is a Florida form and can be used in Securities Offerings-Registration Blue Sky Secretary Of State . |
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FILE NO. ________________ VAL. NO. ________________ AMT. DATE ______ FOR OFFICE USE ONLY STATE OF FLORIDA OFFICE OF FINANCIAL REGULATION NOTIFICATION REGISTRATION SECTION 517.082, FLORIDA STATUTES (Notification may be made by the issuer, by a registered dealer, by any person on whose behalf the offering is to be made, or by a duly authorized agent of such person.) NOTE: The general information required on this form must be supplied by every notifier. A fee of $1,000 shall accompany every application for registration. Checks should be payable to: Department of Financial Services. NOTICE: THIS FORM IS TO BE USED ONLY WHERE A REGISTRATION STATEMENT COVERING THE SECURITIES AND OFFERING DESCRIBED HEREIN HAS BEEN FILED WITH THE SECURITIES AND EXCHANGE COMMISSION AND THERE IS NO PROHIBITION FROM REGISTRATION UNDER SECTION 517.082(3), FLORIDA STATUTES. PART I. Item 1. GENERAL INFORMATION Name and address of the issuer and principal office. Federal Employer Number: Item 2. Identification (FEID) Name, address and telephone number of correspondent to whom notice and communications regarding this notification may be sent. Item 3. Name and address of notifier. Item 4. Issuer organized under the laws of ______________ Date: Item 5. Notification Registration under Section 517.082, Florida Statutes, is made for the securities to be effectively registered under SEC Reg. No. ___________________ OFR-S-3-91, Notification Registration, Effective 11/22/10, Incorporated by Reference in Rule 69W-301.002, F.A.C. 1 American LegalNet, Inc. www.FormsWorkFlow.com PART II. Exhibit 1. Exhibit 2. Exhibit 3. NOTIFIER SHALL FURNISH THE FOLLOWING EXHIBITS: NOT BE INCORPORATED BY REFERENCE EXHIBITS MAY One copy of Initial Registration Statement filed with the Securities and Exchange Commission unless effective with the SEC upon filing with the Office. Issuer's Consent to Service of Process and Corporate Resolution to be executed upon Office forms or appropriate Securities and Exchange Commission forms. One copy of the Final Pricing Amendment/Prospectus. **For renewal purposes: an issuer need not submit Exhibit 1. A copy of the current prospectus may be submitted for Exhibit 3. PART III. THROUGH EXECUTION OF THIS APPLICATION, NOTIFIER HEREBY AGREES THAT THE ISSUER OR THE ISSUER'S REPRESENTATIVE WILL: 1. Furnish any other information requested by the Office. 2. Notify the Office by telegraphic notice of effective registration with the SEC within 10 business days of such registration unless effective with the SEC upon filing with the Office. 3. Furnish all documents within 60 days of such registration. 4. Make all sales in Florida through the issuer lawfully registered with the Office as a Dealer or through any other dealer lawfully registered with the Office. Signed this day of , . By signing my name below, I declare that I have read the foregoing application and that the facts stated in it are true. ________________________________________ NAME OF NOTIFIER By: ___________________________________ SIGNATURE, AND OFFICIAL CAPACITY OR PERSON SIGNING FOR NOTIFIER NOTE: THE REGISTRATION PURSUANT TO SECTION 517.082, FLORIDA STATUTES, IS SUBJECT TO RECEIPT OF ALL DOCUMENTS AS REQUIRED. ALL OFFERS AND SALES IN FLORIDA MUST BE MADE BY THE ISSUER AS A REGISTERED FLORIDA DEALER OR OTHER REGISTERED FLORIDA DEALERS. OFR-S-3-91, Notification Registration, Effective 11/22/10, Incorporated by Reference in Rule 69W-301.002, F.A.C. 2 American LegalNet, Inc. www.FormsWorkFlow.com
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