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Small Issue Registration Document And Disclosure Checklist 8-S - Georgia
| Small Issue Registration Document And Disclosure Checklist Form. This is a Georgia form and can be used in Securities And Business Regulation Blue Sky Secretary Of State . |
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SECURITIES AND BUSINESS REGULATION 237 Coliseum Drive Macon, Georgia 312173858 (478) 2072440 http://www.sos.state.ga.us/securities/ SMALL ISSUE REGISTRATION Document and Disclosure Checklist Georgia Securities Act of 1973, As Amended OCGA 1055(e) APPLICANT: Office Use ONLY Control #: __________ Examiner: __________ Description of Document/Disclosure 1. STATUTORY LIMITATION (Circle A or B) A. Maximum aggregate offering of $1,000,000 with an unlimited number of investors; OR B. Maximum of 50 investors with an unlimited aggregate offering 2. APPLICATION FOR REGISTRATION A. Complete all applicable parts of Form 8 B. Document and Disclosure Checklist C. Manual signatures of officers and directors 3. CORPORATE DOCUMENTS A. Articles of Incorporation B. Bylaws C. Management or other material contracts D. Indenture or other instrument relating to the securities to be registered E. Consent to Service of Process F. Corporate resolution authorizing consent G. Date and place organized 4. DESCRIPTION OF OFFERING A. Type of securities B. Number offered C. Offering price and how computed D. Aggregate offering E. General purpose of offering F. Specific use of proceeds G. Commission, discounts and expenses of offering 5. DIRECTORS, OFFICERS AND CONTROL PERSONS A. Compensation to officers, directors and affiliates B. Statement concerning all previous securities or proposed transactions with issuer C. Material interest in any material transaction within past three years, or any proposed transaction 6. ESCROW A. Minimum business plan B. Agreement to escrow securities C. Agreement in escrow proceeds D. Petition for waiver of escrow E. Letter from escrow agent regarding release of funds notification OCGA 105 5(e)(1)(A) Regulation D Rule 504 5(e)(1)(B) 5(e)(2) 5(e)(2) 5(e)(3)(E) 5(e)(2) 6(c) 6(c) 5(e)(3)(A) 5(e)(3)(C) 5(e)(3)(D) 12(a)(2) 5(e)(3)(D) 5(e)(3)(D) 6(e); 59043.01 American LegalNet, Inc. www.FormsWorkFlow.com Form 8S Rev. 2/2011 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com Office Use ONLY Control #: __________ Examiner: __________ APPLICANT: Location Description of Document/Disclosure 7. FEES A. Initial Registration: 1/20 of 1% of aggregate offering ($250 min.) B. Renewal: $100 C. Additional assessments D. Reports: $10 8. FINANCIAL STATEMENTS A. 90 day unaudited balance sheet B. Profit and loss statement C. Projections and forecasts 9. LEGAL AND PROFESSIONAL OPINIONS AND STATEMENTS A. Manually signed copy of opinion, certification or report identified in prospectus B. Written consent by anyone whose opinion or statement will be used in connection with the offering 10. LEGENDS A. Rescission B. Disclaimer C. Forecasts and projections D. Negotiability legend E. Restricted legend 11. LITIGATION, MATERIAL A. Issuer B. Officers, directors and affiliates 12. PROSPECTUS A. Draft copy B. Final dates copy C. Sales literature D. Literature for selling group E. Rescission forms 13. RISK FACTORS A. Competition B. Litigation C. Conflicts D. Key officials E. Investigative proceedings F. Market conditions G. Track record H. Dilution Page 2 of 2 OCGA 105 6(a) 6(i) 59043.08 6(j) 5(e)(3)(B) and 5(e)(7) 5(e)8 5(e)(3)(C) 6(d) 5(e)(3)(E) 19 5(e)(1)(B) 5(e)(3)(E) and 12(a)(2) 5(e)(3) 5(e)(3)(C) 12(a)(2) and 5(e)(3)(E) Form 8S Rev. 9/2010 American LegalNet, Inc. www.FormsWorkFlow.com Office Use ONLY Control #: __________ Examiner: __________ APPLICANT: Location Description of Document/Disclosure 14. SELLING SHAREHOLDERS (AFFILIATES) A. Name and address B. Amount of securities owned C. Relationship to issuer 15. SPECIMEN OF SECURITIES TO BE ISSUED 16. STOCK/SECURITIES OPTIONS DESCRIPTION 17. STOCK SUBSCRIPTION AGREEMENT A. Investment intent B. Negotiable instruments 18. UNDERWRITING OR SELLING GROUP AGREEMENT Form 8S Rev. 9/2010 OCGA 105 5(e)(1) 5(e)(1)(B) 5(e)(3)(C) 5(e)(1)(B) 19 12(a)(2) 5(e)(3)(C) 19. USE OF PROCEEDS Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com
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