Washington > Secretary Of State > Blue Sky > Securities
Notification Of Claim Exemption (Nonprofit Organization) - Washington
| Notification Of Claim Exemption (Nonprofit Organization) Form. This is a Washington form and can be used in Securities Blue Sky Secretary Of State . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
Notification of Claim of Exemption Department of Financial Institutions Securities Division Nonprofit Organization - RCW 21.20.310(11) P.O. Box 9033 Olympia, WA 98507-9033 360-902-8760 (If insufficient space is available for answers, please attach sheet with additional information) 1. Issuer Name Address Phone Number ( ) 2. Officers and directors Names, Addresses and Phone numbers 3. Nature and purposes of organization As basis for claiming exemption Issuer is a (check one) 1 religious 2 educational 3 charitable 4 fraternal organization Include proof of current tax exempt status under the Internal Revenue Code. 4. This offering Description of security Price per security Number of securities to be offered 5. Short description of the proposed use of proceeds from the sale of securities Issuer shall provide a prospective purchaser written information regarding the securities offered prior toconsummation of any sale, which information shall conspicuously disclose the following statements:SC-610-231 (R/5/94)W Page 1 of 2 <<<<<<<<<********>>>>>>>>>>>>> 2 Any prospective purchaser is entitled to review financial statements of the issuer which shall be frunished upon request. Receipt of notice of exemption 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 offering. Any representation to the contrary is a criminal offense. The return of the funds of the purchaser is dependent upon the financial condition of the organization. Filing fee of $50 to accompany this notice of exemption. Please make checks payable to the state treasurer. Pursuant to the requirements of RCW 21.20.310(11), the issuer has duly caused this Notification of Claim of Exemption to be signed on its behalf by the undersigned officer or person acting in a similar capacity. Dated this day of , 20 . Issuer Signature of issuers representative Type name Type title Subscribed and sworn to before me this day of , 20 . (Seal) Signature Notary public in and for the state of Washington Residing at ATTENITON: INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACTS CONSTITUTE CRIMINAL VIOLATIONS. SEE RCW 21.20.400. SC-610-231 (R/5/94)W Page 2 of 2
|
|||||||
