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Act Of 1972 For Retroactive Registration Of Investment Company Securities 210 - Pennsylvania
| Act Of 1972 For Retroactive Registration Of Investment Company Securities Form. This is a Pennsylvania form and can be used in Securities Blue Sky Department Of State . |
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PSC/FORM 210 EFF: 9-23-95 COMMONWEALTH OF PENNSYLVANIA PENNSYLVANIA SECURITIES COMMISSION * * * * * * * * * APPLICATION UNDER SECTION 210 OF THE PENNSYLVANIA SECURITIES ACT OF 1972 FOR RETROACTIVE REGISTRATION OF INVESTMENT COMPANY SECURITIES Issuer Information 1. Exact name of Investment Company: 2. Address: 3. Contact Person: 4. Telephone: 5. Fax: Registration Information 6. State the time period during which the securities intended to be covered by this application for retroactive registration were sold in Pennsylvania: 7. Describe the securities and the amount sold in Pennsylvania during the t ime period described in Item 6 above: 8. What was the Investment Companys Pennsylvania registration file number for the period described in Item 6 above: Civil, Criminal or Administrative Proceedings 9. As of the date filing Form 210 with the Commission, is the Investment Co mpany identified in Item 1 the subject of any civil, criminal or administrative proceeding f or violation of Section 201 of the 1972 Act:YES NO If the response is YES, the retroactive registration provisions of Section 210 are not available to the applican t. Calculation of Oversale Assessment Payable 10. Using the fee schedule in Section 602.1(b) of the 1972 Act, determi ne the amount of fees payable to the Commission based upon the total amount of securities s old (registered and oversold securities) during the effective registration period in Pennsy lvania that included the time period described in Item 6. Enter Fee Payable Amount Here: $ 11. Enter the aggregate amount of fees paid by the Investment Company (incl uding any fees paid in connection with amendment filings) during the effective registration period in Pennsylvania that included the time period described in Item 6. Enter Total Amount of Fees Paid Here: $ American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 PSC/FORM 210 PAGE 2 12. The oversale assessment is three times the difference between Item 10 an d 11. If the oversale assessment is less than $350, the oversale assessment due is $350. If t he oversale assessment is greater than $3,000, the oversale assessment is $3,000. Enter the Amount of the Oversale Assessment Due Here: $ Affirmation 13. Each person executing this Form on behalf of the Investment Company here by affirms that: (a) he/she is familiar with the provisions of Section 201, 210 and 602.1 of the 1972 Act and all regulations adopted thereunder, including Regulation 210.010; and (b) the statements made herein, including all attachments thereto, a re not incomplete in any material respect or false or misleading with respect to any material fact. IN WITNESS WHEREOF, This application has been duly executed this day of ,19 . (Name of Investment Company) BY: (Title) American LegalNet, Inc. www.USCourtForms.com
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