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Reorganization Exemption Application 14-2P - Utah

Reorganization Exemption Application Form. This is a Utah form and can be used in Securities Blue Sky Department Of Commerce .
 Fillable pdf Last Modified 10/6/2005
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Page 1 of 3 (Rev. 11/16/1998) STATE OF UTAH DEPARTMENT OF COMMERCE UTAH SECURITIES DIVISION FORM 14-2p Reorganization Exemption Application 1. (Name of Applicant) 2. (Address of Applicant) (Telephone #) 3. (Name & Address of Correspondent) (Telephone #) 4. (Expected date of commencement of offering) 5. Transaction to be exempt (check one): Reclassification/Recapitalization Merger/Consolidation (Name & Address of other party/parties to transaction) Transfer of Assets (Name & Address of other party/parties to transactions) American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2Form 14-2p (Rev. 11/16/98)Page 2 of 3 6. Securities to be distributed: TITLE AMOUNT CONSIDERATION 7. Securities to be exchanged (if any): TITLE AMOUNT CONSIDERATION 8. Present number of holders of applicant: Present number of holders of other person (if any): Number of holders if offering is completed: 9. Brief description of the transaction, including dates and names of perso ns involved: American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 3Form 14-2p (Rev. 11/16/98) Page 3 of 3 State of ) ) ss County of ) On , the undersigned, ,being first duly sworn, deposes and says that he or she has executed the fore going application for and on behalf of the applicant, that he or she is the of such applicantand is fully authorized to execute and file such application, that he or sh e is familiar with such application, and that to the best of his or her knowledge, information and belief, t he statements made in such application are true and the documents submitted herewith are true copies of the originals thereof. (Signature) Subscribed and sworn to before me this day of , . (Notary Public) The undersigned directors, partner or partners of the issuer named herein do hereby aff irm that they have read this application and all exhibits thereto, and that the contents thereof are true to the best of their knowledge and belief; and further that is hereby authorized to execute this application on behalf of the issuer, and continuing authority is hereby delegated to him or her to file any amendments, supplementary or period ic information thereto as may be applicable or required, pursuant to the Utah Uniform Securities Act, and rules promulgated thereunder. NAME SIGNATURE American LegalNet, Inc. www.USCourtForms.com
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