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Annual Notice Of Claim Of Exemption (Franchise) - Washington
| Annual Notice Of Claim Of Exemption (Franchise) Form. This is a Washington form and can be used in Securities Blue Sky Secretary Of State . |
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State of Washington Department of Financial Institutions Securities Division P.O. Box 9033 Olympia, WA 98507-9033 360-902-8760 ANNUAL NOTICE OF CLAIM OF EXEMPTION PURSUANT TO RCW 19.100.030(4) (a), (b) (i) and (c)ANNUAL FILING FEE OF $100 IS PAYABLE TO THE STATE TREASURER Type or print application Initial Application Renewal File No.1. Name of Franchisor: (Subfranchisor if applicable): 2. Name of Franchisee: 3. Address of Claimant (and mailing address, if different): 4. Telephone Number: 5. Name of person to whom communications regarding this notice should be s ent: Address: Telephone Number: 6. Description of business to be franchised: SC-610-259 FRAN.CLAIM OF EXEMPTION (N/7/91)M Page 1 of 2 <<<<<<<<<********>>>>>>>>>>>>> 2The undersigned franchisor represents that it:(1) shall provide prospective purchasers in the state of Washington an offer ing circular, that complies withguidelines adopted by the director, at least ten business days prior to the signing of an agreement or receipt ofconsideration; (2) (check the applicable box) has a net worth on a consolidated basis, according to its most recent au dited financial statement, of not less than $5,000,000; or has a net worth of $1,000,000 according to its most recent audited finan cial statement and is at least 80% owned by a corporation which has a net worth on a consolidated basis , according to its most recent audited financial statement, of not less than $5,000,000;(3) (check the applicable box) has had at least 25 franchisees conducting business at all times during the five year period immediately preceding the offer or sale; or has conducted business which is the subject of the franchise continuousl y for not less than five years preceding the offer or sale; or is owned 80% or more by a corporation which has had at least 25 franchis es conducting business continuously for not less than five years immediately preceding the offer or sale; or is owned 80% or more by a corporation which has conducted business which is the subject of the franchise continuously for not less than five years preceding the offer or sale;(4) requires a minimum investment of more than $100,000; and(5) has not been found by a court to be in violation of state or federal fra nchising or consumer protection laws in the past seven years. Attach a copy of the franchisors most recent audited financial statements (and, if applicable, those o f anycorporation upon whose financial statements the franchisor is relying to qualify for the exemption).Do not send a copy of the offering circular or agreement unless requeste d to do so.This claim of exemption will be effective for a period of twelve months from the date it is granted effectiveness.A renewal notice should be filed ten business days prior to the expirati on of the effective period.____________20Certified this _________________ day of ____________________, by___________________________________________________________________ Signature Type or Print Name and Titlefor Type or Print Name of FranchisorSC-610-259 FRAN.CLAIM OF EXEMPTION (2/96) Page 2 of 2
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