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Application For Exemption From Registration MTAER - Montana
| Application For Exemption From Registration Form. This is a Montana form and can be used in General Blue Sky Secretary Of State . |
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STATE OF MONTANA APPLICATION FOR JOHN MORRISON STATE AUDITOR EXEMPTION COMMISSIONER OF SECURITIES 840 Helena Avenue FROM REGISTRATION Helena, Montana 59601 (406) 444-2040 1. Name, address, and telephone number of issuer. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 2. Name, address, and telephone number of contact person. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 3. Description of Securities. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Type Units Amount Units in MT Amt. in MT _______ _______ _______ ____________ ______________ _______ _______ _______ ____________ ______________ _______ _______ _______ ____________ ______________ _______ _______ _______ ____________ ______________ 4(a). List the states in which it is proposed to offer the securities for sale. _______________________________________________________________________ _______________________________________________________________________ 4(b). List the states in which the securities are eligible for sale. _______________________________________________________________________ _______________________________________________________________________ 4(c). List the states which have refused, by order or otherwise, to authorize the sale of the securities, or have revoked or suspended the right to sell the secur ities, or in which an application has been withdrawn. _______________________________________________________________________ _______________________________________________________________________ 5. State the federal statute or rule under which the offering will be made. _______________________________________________________________________ American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 6(a). Furnish the indicated information about each officer, director and promoter, and every individual who directly or indirectly owns or controls 10% or more of any class of security in the issuer. Name Position % OWNERSHIP % OWNERSHIP BEFORE OFFERING AFTER OFFERING ______________ ______________ __________________ ________________ ______________ ______________ __________________ ________________ ______________ ______________ __________________ ________________ ______________ ______________ __________________ ________________ ______________ ______________ __________________ ________________ ______________ ______________ __________________ ________________ ______________ ______________ __________________ ________________ 6(b). Provide the name of each listed person who, during the previous ten years, has been charged with or convicted of a felony, or entered a plea of guilty or nolo contendre to a felony charge involving fraud (including violation of any laws), embezzlement, fraudulent conversion, misappropriation of property or restraint of trade. Include the identity and location of the court and the penalty imposed or sought. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 6(c). Provide the name of each listed person who, during the preceding ten years, has filed in bankruptcy or been adjudged bankrupt, or been recognized as insolvent. Provide the names of listed persons who have been a principal, director, executive officer, or general partner of a natural or artificial person who has filed bankruptcy, been adjudged bankrupt, or been reorganized due to insolvency. Include the nature and date of the action. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 7. Offering: (a) Provide the names and addresses of the sales persons. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ (b) Describe all commissions and other expenses of the sale. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ (c) State whether investors are required to buy a minimum amount of the issue. If yes, describe. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 3(d). If the offering is limited to a special group, describe the limitations. Examples are employees of the issuer, a certain number of individuals (as required to qualify under subchapter S of the Internal Revenue Code, persons of certain suitability characteristics, or any other limitations. _______________________________________________________________________ _______________________________________________________________________ (e) State whether a disclosure document is used in connection with sales or offers of the security? __________________ 8. Describe the restrictions on subsequent transfer of any interest in the securities. State whether the certificates bear a legend notifying holders of restrictions. _________ ______________________________________________________________________ ______________________________________________________________________ 9. Summarize the business of the issuer. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________
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