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Uniform Notice Of Transaction-Accredited Investor Exemption ACCR-INV - New Mexico
| Uniform Notice Of Transaction-Accredited Investor Exemption Form. This is a New Mexico form and can be used in Securities Blue Sky Public Regulation Commission . |
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(Rev. 01/10) UNIFORM NOTICE OF TRANSACTION ACCREDITED INVESTOR EXEMPTION STATE OF NEW MEXICO NOTICE OF SALE OF SECURITIES PURSUANT TO ACCREDITED INVESTOR EXEMPTION UNDER RULE 12.11.12.19 NMAC 1. Issuer Name: ___________________________________________________________________ Address: _________________________________________________________________ Phone Number: ____________________________________________________________ 2. Form of Organization (Check One) Corporation Unincorporated Association Limited Liability Company Limited Partnership Other (Specify)_____________________________________ Issuer's state of Incorporation or jurisdiction or organization _________________________ Date of Incorporation or Organization ___________________________________________ 3. Officers and Directors (or persons acting in a similar capacity) Names, Addresses, and Phone Numbers: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com 4. This Offering. Price per security: Description of Security: (check one box) Debt Equity (common) Equity (preferred) Covertible Partnership Interests Other (Specify) ________________ Number of securities to be offered: Aggregate dollar amount: 5. Description of business: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 6. Name of Broker-Dealer who has solicited or intends to solicit purchasers in this state: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 7. Business Address: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ By filing this Notice of Transaction, the Issuer of these securities hereby represents that: 1. Sales of securities shall be made only to accredited investors as defined in 17 CFR 230.501(a). The Issuer is not an issuer in the development stage that either has no specific business plan or purpose or has indicated that its business plan is to engage in a merger or acquisition with an unidentified company or companies, or other entity or person. The Issuer reasonably believes that all purchasers are purchasing for investment and not with the view to or for sale in connection with a distribution of the security. Any resale of a security sold in reliance on this exemption within 12 months of sale, except a resale to an accredited investor or pursuant to a registration statement effective under applicable state securities law, shall be presumed to be with a view to distribution and not for investment. Securities issued 2. 3. American LegalNet, Inc. www.FormsWorkFlow.com under this exemption my only be resold pursuant to registration or an exemption under applicable state securities law. The undersigned represents that the Issuer is familiar with the conditions that must be satisfied to be entitled to the Accredited Investor Exemption of the state in which this notice is filed and understands that the Issuer claiming the availability of this exemption has the burden of establishing that these conditions have been satisfied. The Issuer has read this notification and knows the contents to be true and has duly caused this notice to be signed on its behalf by the undersigned duly authorized person. Issuer (Print or Type) Name (Print or Type) Signature Title (Print or Type) Date American LegalNet, Inc. www.FormsWorkFlow.com
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