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Municipal Security Notice Filing (For Issuers Located Outside State Of WA) - Washington

Municipal Security Notice Filing (For Issuers Located Outside State Of WA) 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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State of Washington Department of Financial Institutions Securities Division P.O. Box 9033 Olympia, WA 98507-9033 (360) 902-8760 MUNICIPAL SECURITY NOTICE FILING for issuers located outside the State of Washington1. CONTACT PERSON Name_______________________________________________________________________________ Address_____________________________________________________________________________ Phone Number____________________ Fax________________________ E-Mail__________________2. ISSUER OF SECURITIES Name_______________________________________________________________________________ Address_____________________________________________________________________________3. USER OF PROCEEDS Name_______________________________________________________________________________ Address_____________________________________________________________________________4. SHORT DESCRIPTION OF SECURITIES COVERED BY THIS NOTICE ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________5. FEE (check payable to Washington State Treasurer--minimum fee is $100 for the first $100,000 of th securities to be offered in Washington, plus 1/20 of 1% for any amount in excess of $100,000). Amount Paid_________________________________________________________________________ Amount of Securities to be Offered in Washington____________________________________________Municipal Security Notice Filing-1 (4/97) <<<<<<<<<********>>>>>>>>>>>>> 26. FORM U-2/U-2a UNIFORM CONSENT TO SERVICE OF PROCESS (select one) ___ Is already on file with Washington and is incorporated by reference. ___ Is attached.7. SIGNATURE Under penalty of perjury under the laws of the State of Washington, the undersigned certifies that this notice has been filed on behalf of, and with the authority of, the issue r. The undersigned and the issuer represent that the information and statements, and other information fil ed, are current, true and complete to the best of his or her knowledge, information and belief, and that th e securities covered by this notice are covered securities as defined by the National Securities Markets Imp rovement Act of 1996. Dated this _______ day of ______________________________, 20_____. For:____________________________________________________________________ ____________ (Name of Issuer) By:_____________________________________________________________________ ____________ (Signature of Authorized Agent of Issuer) ________________________________________________________________________ ____________ (Print Name) ________________________________________________________________________ ____________ (Title of Agent for Issuer)Note: While not required, the issuer may want to include a copy of the offering document, or at least thetitle page, so that it is clear what securities are intended to be cover ed by this notice filing.Municipal Security Notice Filing-2 (4/97)
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