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Application For Registration By Qualification - Mortgage Paper Securities - Washington

Application For Registration By Qualification - Mortgage Paper Securities Form. This is a Washington form and can be used in Securities Blue Sky Secretary Of State .
 Fillable pdf Last Modified 10/6/2005
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APPLICATION FOR REGISTRATION BY QUALIFICATION PURSUANT TO WAC 460-33A Mortgage Paper Securities Initial Renewal1. Name and address of registrant:___________________________________________________________________________________________________________________________________ ______________2. Name and address of issuer (if different from registrant)________________________________________ ________________________________________________________________________ ______________________________________________________________________________________ ______________3. Name, address, telephone number and facsimile number (if any) of th e person to contact with respectto this filing: ________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________4. Short description of securities sought to be registered (such as "un divided participation interests innotes secured by deeds of trust on real estate located in Washingtonstate"):________________________________________________________________________ ________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________5. Dollar amount of mortgage paper securities sought to be registered in Washington:________________________________________________________________________ ____6. Dollar amount of securities to be offered in all states (includingWashington):________________________ 7. Anticipated maximum price per mortgage paper security:_______________________________________ 8. Fee ($100 for the first $100,000 of mortgage paper securities to be registered in this state plus 1/20 of1% for any amount to be registered in excess of $100,000): ________________________ [the checkshould be made payable to the Washington State Treasurer] 9. Fiscal year end: _________________ 10. The issuer complies with the net worth or bond requirements by satis fying the requirements of (checkthe appropriate box): A. WAC 460-33A-040(1)(a) - Tangible Net Worth of the greater of $100,0 00 or 10% of the amount to be registered up to a maximum of $1,000,000; orB. 0,000 Surety Bond; or01 WAC 460-33A-040(1)(b) - $ <<<<<<<<<********>>>>>>>>>>>>> 2C. WAC 460-33A-040(1)(c) - Tangible Net Worth of $5,000 (available only if the mortgage broker-dealer and it affiliates do not handle lenders or borrowers funds).For those issuers relying upon "A" or "C" above, attach a copy of your most recent fiscal year-end andinterim financial statements. For those issuers relying upon "B," a copy of the surety bond must besupplied. STATE OF WASHINGTON County of _________________ ___________________________, being first duly sworn, deposes and says: I have been authorized bythe registrant to execute and file this application. I have read this application and the exhibits filed with itand swear, to the best of my knowledge, information and belief, and knowing that false swearing is acrime, that the facts stated in the application and in the exhibits are true, correct and complete. ____________________________________ Signature ____________________________________ Name (printed or typed) ____________________________________ Title Subscribed and sworn to this ____ day of _________, ______. ____________________________________This application and the necessary exhibits and attachments, including those required by WAC 460-33A-020, should be sent to: Washington State Securities Division PO Box 9033 Olympia WA 98507-9033 (360)902-8760 FAX (360)586-5068Applicants should also note that compliance with the broker-dealer and salesperson registrationrequirements of RCW 21.20.040, WAC 460-33A-080, and WAC 460-33A-085 will be required before apermit for the sale of mortgage paper securities may be granted.<<<<<<<<<********>>>>>>>>>>>>> 3 SUGGESTED CONTENTS FOR GENERAL OFFERING CIRCULARS PURSUANT TO WAC 460-33AThe following information, to the extent applicable, should be included in general offering circulars filedpursuant to WAC 46033a. The registrant is required to disclose all material facts concerning the issuerand the offering. I. Cover Page - Information required. A. Caption identifying who is making the offering, general types of securities covered, and aggregate dollar amount to be offered. B. Name and address of registrant. C. Legends: 1. This offering has been registered with the Securities Division of the state of Washington as a mortgage paper securities offering under the provisions of Ch. 460-33A WAC. 2. The mortgage paper securities offered under this general offering circular have not been registered with the Securities and Exchange Commission under the Securities Act of 1933, as amended (the Act), and are offered in reliance upon the exemption from registration found in Section 3 (a) (11) of the Act and Rule 147 thereunder. Accordingly, resales and transfers of the mortgage paper securities described in the specific offering circular are strictly limited to residents of the state of Washington for a period of at least nine months from the date of the last sale of mortgage paper securities described in the specific offering circular. 3. These securities involve a high degree of risk and are offered only to investors who are bona fide residents of the state of Washington and who meet certain suitability requirements. The registration of these securities by the Washington Administrator of Securities does not signify that the Administrator has approved or recommended these securities nor has the administrator passed upon the adequacy or accuracy of this offering circular. Any representation to the contrary is a criminal offense. 4. See Remedies of Investors for False or Misleading Statements, page _____; Risk Factors, page _____; Possible Conflicts of Interest, page _____; and Compensation, page _____. D. Date of the prospectus. (Leave blank until reviewed)II. Table of Contents indexed by page/paragraph number.III. Business and Organization of Issuer in Brief Form.IV. Definitions. Technical terms used in the prospectus should be defined in a glossary or as they appear in the prospectus. V. Risk factors. Set forth the most
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