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Jersey Registration Statement For Registration By Notification NJBOS-6 - New Jersey
| Jersey Registration Statement For Registration By Notification Form. This is a New Jersey form and can be used in Securities Blue Sky Secretary Of State . |
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NEW JERSEY BUREAU OF SECURITIES 153 Halsey Street, 6th Floor PO Box 47029 Newark, NJ 07101 (973) 504-3600 NEW JERSEY REGISTRATION STATEMENT FOR REGISTRATION BY NOTIFICATION All items must be answered. Attach riders where necessary. I. DESCRIPTION OF ISSUER A. Name: ________________________________________________________________ B. Address: ________________________________________________________ ______ C. Form of organization: State: ___________________________________________________ Date organized: ___________________________________________ D. General character of business: __________________________________ ___________ _______________________________________________________________ _______ E. Principal place of business: ____________________________________ ___________ _______________________________________________________________ _______ II. DESCRIPTION OF SUBSIDIARIES (State the information requested in Question I for each significant subsidiary of the iss uer.) ________________________________________________________________________ __ ________________________________________________________________________ __ ________________________________________________________________________ __ III. DESCRIPTION OF APPLICANT (Complete if applicant is not the issuer.) A. Name: ________________________________________________________________ B. Address: ________________________________________________________ ______ C. Relationship to issuer: _________________________________________ __________ American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2IV. INFORMATION REGARDING NONISSUER DISTRIBUTION (Complete only if offering or any part thereof is for the benefit of selling securityholders.) A. Name of each person on whose behalf any part of the offering is to be made: _______ _____________________________________________________________ ________ _____________________________________________________________ ________ B. Address(es): ________________________________________________ __________ _____________________________________________________________ ________ _____________________________________________________________ ________ C. Amount of securities currently held by each selling securityholder: ______ _________ _____________________________________________________________ ________ _____________________________________________________________ ________ D. Reason (purpose) for making this offering: __________________________________ _____________________________________________________________ ________ _____________________________________________________________ ________ V. DESCRIPTION OF SECURITIES Offering price Total offering Offering in this state Description or proposed # of shares $ of shares # of shares $ of sharesof securities offering price or units or units or units or units ____________ ___________ _________ _________ _________ _________ ____________ ___________ _________ _________ _________ _________ ____________ ___________ _________ _________ _________ _________ ____________ ___________ _________ _________ _________ _________ Totals _________ _________ _________ _________ American LegalNet, Inc. www.USCourtForms.comPage 2<<<<<<<<<********>>>>>>>>>>>>> 3VI. INFORMATION AND DOCUMENTS REQUIRED A. States in which a registration statement or similar document in connection with this offering has been or is to be filed. _______________________________________ ____________ ___________________________________________________________________ _____ B. State whether any withdrawal or any adverse order, judgment, or decree has been entered in connection with this offering by the regulatory authorities in any state or by any court or by the Securities and Exchange Commission. _____________________________________ If so, give details. ______________________________________________ ___________ ___________________________________________________________________ _____ C. (1). Proposed offering price per unit (or the method by which it is to be computed). ____________________________________________________________ ________ ____________________________________________________________ ________ (2). State whether the price will vary as to any person or class of persons other than underwriters. ______________________________________________ ___________ If so, give details. _______________________________________ ______________ ____________________________________________________________ ________ (3). Is this offering, or any part thereof, to be made other than for cash? ______________ If so, give details. _______________________________________ ______________ ____________________________________________________________ ________ D. (1). Estimated aggregate underwriting and selling discounts or commissions and finders fees. Show each means of payment separately (e.g., cash, securities, contracts). _________ ____________________________________________________________ ________ (2). If the selling discounts and commissions are variable, state the basis of determining them, American LegalNet, Inc. www.USCourtForms.comPage 3<<<<<<<<<********>>>>>>>>>>>>> 4 including their maximum and minimum amount. _____________________________ ____________________________________________________________ ________ (3). State the estimated amounts of other selling expenses, including legal, engineering and accounting expenses. _______________________________________ ____________ ____________________________________________________________ ________ E. (1). The name and address of every underwriter, agent, broker-dealer or other recipi ent of a commission, discount or finders fee. (Submit the underwriting agreement or form of underwriting agreement as an exhibit.) _____________________________________ ____________________________________________________________ ________ (2). If the securities are not to be offered through an underwrit er, describe the plan of dis- tribution. _________________________________________________ ___________ ____________________________________________________________ ________ (3). Identify the agent or broker-dealer registered in New Jersey who will offer the securities or state the applicable exemption. _________________________________________ ____________________________________________________________ ________ F. Description of any stock options outstanding or to be created in connection with this offering. ____________________________________________________
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