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Registration By A Corporation Of A Proposed Sale Of Additional Securities To Existing Security Holders 6(A)(4) - Ohio
| Registration By A Corporation Of A Proposed Sale Of Additional Securities To Existing Security Holders Form. This is a Ohio form and can be used in Securities Blue Sky Secretary Of State . |
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Telephone: (614) 644-7381 STATE OF OHIO Department of Commerce File No. Division of Securities 77 South High Street, Columbus, Ohio 43215-6131 Form 6(A)(4) Registration by a Corporation of a Proposed Sale of Additional Securities to Existing Security Holders Pursuant to R.C. Section 1707.06(A)(4). Date Checked By Notation Registrant Must Not Complete. Division Record -Fee ($50.00) Received Prior registrations checked Examined as to form Amendment requested Accepted for filing Acknowledgment sent Registration withdrawn Registration suspended Registration refused Examination requested This Registration (Registrant Must Not Complete.) (Section) (File) (Date) (Amount) (Price) (Description) Note: Use this form if sub-items (a), (b) and (c) of item 11 can be answered in the affirmative. Check each of these sub-items before starting to complete this form. If the space provided on this form is inadequate for full response, attach an exhibit numbered to correspond to the number of the question thereby answered. Integration: The issuer should be aware that all sales of securities before or after this filing may be subject to integration with this offering by the Division. Factors considered particularly relevant to integration include: 1) Are the offerings part of a single plan of financing? 2) Do the offerings involve issuance of the same class of security? 3) Are the offerings made at or about the same time? 4) Is the same type of consideration to be received? 5) Are the offerings made for the same general purpose? COMPLETE ALL ITEMS 1. 2. 3. 4. 5. Issuer's corporate name Issuer's principal business office Statutory Agent: (Name) (Street and Number) (Street and Number) (Month, Day and Year) (City, State, Zip) (City, State, Zip) (City, State, Zip) (Payer's Federal Tax Identification Number) (Phone) (Phone) (State) Date and state of issuer's incorporation: State specifically the actual business in which issuer is engaged or will engage: COM 4593 (Rev. 9/05) American LegalNet, Inc. www.FormsWorkFlow.com 6. Securities authorized and securities sold: a. Shares now authorized by Articles of Incorporation, including amendments, if any: I Common II Preferred III Other Classes Description _____________________ No. of Shares _________________ Par Value ____________________ Voting ______________________ No. of Shares ____________________ Par Value _______________________ Dividend Rate ___________________ Cumulative _____________________ Voting _________________________ b. Total number of shares sold, issued or subscribed to date. I Common No. of Shares _________________ c. II Preferred No. of Shares ____________________ III Other Classes No. of Shares ____________________ No. of Shares ____________________ Par Value _______________________ Dividend Rate ___________________ Cumulative _____________________ Voting _________________________ Attach an exact copy of any language in the Articles of Incorporation, including amendments, and in the Code of Regulations or By-Laws relating to: (1) voting rights; (2) dividend rights; (3) liquidation rights; (4) pre-emptive rights; (5) subscription rights; (6) conversion rights; and (7) redemption provisions of the issuer's shares. If no rights are expressly given by the Articles, Code of Regulations or By-Laws, a statement should be made that shareholders have only such rights as are provided by statute. d. Describe briefly issuer's outstanding securities other than shares, such as issues of notes, bonds, debentures, trust certificates, etc. State: (1) amount outstanding; (2) date of issue; (3) date of maturity; (4) interest rate; (5) nature of security therefore; and (6) conversion rights. (If none, so state.) 7. State number, class, price and amount of all shares, preferred or common, to be the subject matter of the transaction described by this registration for sale in Ohio. (If none, so state.) (No. of Shares) (No. of Shares) (Description of Shares) (Description of Shares) (Exact Sale Price of Share) (Exact Sale Price of Share) (Total Sale Price of all Shares) (Total Sale Price of all Shares) 8. State the number, class, price and amount of issuer's shares of all classes to be sold outside of Ohio. (If none, so state.) (No. of Shares) (No. of Shares) (Description of Shares) (Description of Shares) (Exact Sale Price of Share) (Exact Sale Price of Share) (Total Sale Price of all Shares) (Total Sale Price of all Shares) American LegalNet, Inc. www.FormsWorkFlow.com 9. Describe briefly and state number, class, price and amount of issuer's securities other than shares, such as promissory notes, bonds or debentures: a. To be the subject matter of the transaction described by this registration for sale in Ohio. (If none, so state.) b. To be sold outside Ohio. (If none, so state.) 10. a. Are the securities which are the subject matter of this registration to be sold exclusively for cash? YES NO If not, furnish Exhibit C stating: (1) what will be received for such securities; (2) the number and class of securities to be exchanged therefore; (3) the names and addresses of the persons who will receive such securities; and (4) a sworn appraisal by a competent, disinterested, non-affiliated appraiser or such other proof as may be available with respect to the true value of items other than cash which will be received for such securities. b. 11. Note: This form can be used only if items (a), (b) and (c) below can all be answered in the affirmative. a. b. Will the sale of the above described securities be made by a corporation? YES NO Are the above described securities to be offered exclusively to a class or classes of existing security holders of the above described issuer? YES NO Will the sales of the above described securities be made without the payment, directly or indirectly, of any commission or other remuneration except as may be specified in (d) below? YES NO Answer (d), if applicable. If not applicable, so state. c. d. The above discount, commission or remuneration, if any, to be paid in connection with the offering and sale of the above described securities will be received by a securities dealer, who has agreed to purchase all securities not purchased by security holders to whom this offering is to be made. Attach and mark as Exhibit D a copy of the proposed agreement with such dealer. 12. Attached hereto and made a part of this filing are the following exhibits: Exhibit A - Copy of issuer's balance sheet with appropriate footnotes and profit and loss stat
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