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Application To Register By Qualification Securities Pursuant To Section 1707.09 9 - Ohio
| Application To Register By Qualification Securities Pursuant To Section 1707.09 Form. This is a Ohio form and can be used in Securities Blue Sky Secretary Of State . |
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STATE OF OHIO Telephone Department of Commerce File Number (614) 644-7381 Division of Securities 77 South High Street, Columbus, Ohio 43215-6131 Form 9 Application to Register by Qualification Securities Pursuant to Section 1707.09 of the Revised Code of Ohio Registrant Must Not fill In. Checked Division Record -- Date By Notation Fee ($100 Received) Examination expenses ($ ) received Qualification fee ($ ) received Prior registrations checked Examined as to form Assigned for examination Division Order (Application Refused or Granted) Record Made Registration withdrawn Registration amended Registration suspended Examination requested Prior Registration (RegistrantMust Not Fill In.) (Section) (File) (Date) (Amount) (Description) (Price)This Registration (RegistrantMust Not Fill In.) (Section) (File) (Date) (Amount) (Description) (Price)1. Name of issuer Payers Federal Tax Identification Number2. Principal place of business of issuer Number, Street (City, State, Zip) 3. The issuer is: (State whether individual, partnership corporation, syn dicate, association, etc.) 4. The issuer was incorporated or organized on theday of under the laws of (Month, Year) (State)5. Correspondence relative to this report should be addressed to: (Name) (Number & Street) (City, State, Zip Code) (Phone No.) American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 26. The following are the names and business addresses of all officers, dire ctors, promoters, trustees, partners, or other managers of the issuer: Name Business Address City State7. The purposes and general character of the business actually being transa cted or to be transacted by the issuer are:8. The Articles of Incorporation or other similar document of the issuer au thorize the issuance of the following securities: Amount Description 9. The issuer has the following securities outstanding: (Including all cl asses of stock, bonds, debentures, promissory notes, or other securities.) Amount Description 10. The securities sought to be qualified for sale in Ohio are: Amount Description 11. The entire issue of such securities to be sold both in Ohio and elsewher e is: Amount Description 12. List States other than Ohio in which the securities will be sold. 13. The proceeds of the sale of the securities described in Items 9 and 10 w ill be used for the following itemized purposes: American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 314. The securities are to be offered in Ohio through the following licensed dealer or dealers: Ohio Dealers License Nos.: 15. The price per unit at which the securities described in Items 9 and 10 w ill be offered to the public is: 16. The following is a statement of the aggregate net amount to be received by the issuer after deducting all commissions, remuneration or discounts to be received, directly or indirectly, by per sons distributing or participating in the sale of such securities and after deducting all other expenses of the offering: Aggregate price at which all such securities will be sold:........................ $ Less total commissions, discount or other remuneration:.........................$ Less total of all other expenses of offering..............................................$ Aggregate price of such securities to be sold in Ohio:..............................$ 17. Attached hereto and made a part hereof are the following exhibits: A. A copy of: (1) if the issuer is a corporation, the Articles of Incorp oration, Code of Regulations or By-Laws including all amendments thereto; (2) if the issuer is a trust or trus tee, all instruments by which the trust was declared and the rights of beneficiaries and duties of trustees are gove rned; (3) if the issuer is a partnership, unincorporated association or any other form of organization, the Articl es of Partnership or association and all other similar instruments governing the rights and liabilities of partne rs and members. B. A statement containing complete information regarding the business exper ience of all officers, directors, promoters, trustees, partners or other managers of the issuer during the past five years, including the names and addresses of the firms with which such persons were connected and the po sitions held by each. C. A schedule showing: (1) amount and kind of issuers securities hel d by each officer, director, promoter, trustee, partner or other manager; (2) amount actually received by the issuer f or such securities and whether in cash, real estate, personal property, patents, services or other consideration; (3 ) amount of compensation, salary or other remuneration received or to be received by each of such persons and the time actually devoted by each to the business of the issuer; (4) if any such person is to receive a commiss ion, discount or other remuneration in connection with the sale of the securities sought to be qualified, the a mount thereof. D. A statement containing the name and address of each person owning benefi cially at the date of this application five percent or more of the issuers voting shares. E. Incorporated issuers not domiciled in this state or unincorporated issue rs having a situs of its principal place of business outside this state much file a Form 11 or Form U-2. F. A copy of the corporate, partnership, or other form of organization Reso lution whereby the securities sought to be qualified are authorized or created and whereby the same are to be sold and issued. (Form U-2A, if applicable.) G. Copies of: (1) all indentures, agreements, or other instruments under which any securities of the issuer are issued; (2) all contracts or other instruments pertaining to the sale of the s ecurities for which qualification is sought; (3) all advertisements, prospectuses, circulars, literature, letters, etc., to be used in connection with the sale of such securities. H. A statement of the number and amount of the issuers securities prese ntly registered and unsold in Ohio at the date of this filing. I. A specimen of each type of security to be sold. J. A detailed description of what was paid to the issuer in cash, real esta te, patents, services or other items of value upon sale of the securities listed in Item 8 above. American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 4 K. A detailed description of what is to be received by the issuer in cash, real estate, patents, services or other items of value upon sale of the securities listed in Item
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