California > Secretary Of State > Blue Sky > Securities Regulation Division
Facing Page For Qualification Of Noniusser Transaction By Notification 260.131 - California
| Facing Page For Qualification Of Noniusser Transaction By Notification Form. This is a California form and can be used in Securities Regulation Division Blue Sky Secretary Of State . |
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(Department of Corporations use only) Fee Paid $ _____________________________ Receipt No._____________________________ Effective Date___________________________ DEPARTMENT OFCORPORATIONS FILE NO. ________________________________ (Insert file number of previous filing of issuer before the Department, if any.) Date of Application:________________ FEE: $100.00 DEPARTMENT OF CORPORATIONS STATE OF CALIFORNIA COURT COUNTY .OF. . . .NOTE: .Indicate .the .type . . . . . . .by. checking .the appropriate original or ......... .. . . . . . . . . . . . . . . . . of filing . . . . . . . . . . : amendment application heading shown below. No. Index : [ ] FACING PAGE FOR QUALIFICATION OF NONISSUER TRANSACTION BY NOTIFICATION APPLICATION FOR QUALIFICATION OF SECURITIES UNDER SECTION 25131 OF THE CORPORATE SECURITIES LAW OF 1968 : Calendar No. Plaintiff(s) JUDICIAL SUBPOENA [] AMENDMENT NUMBER_______TO APPLICATION DATED______________________ -against: (Check and complete if applicable) 1. 2. : Name of Issuer___________________________________________________________ (a) Address of principal executive office of issuer. : Defendant(s) _______________________________________________________________________ : . . . . . . . . . . . . . . . . . . Number.and . . . . . . . . . . . . . . . . City . . . . . . . . . . . . . . . . Street ... State Zip code (b) Is the principal location of applicant's books and records at the address of the principal executive office, above? (Indicate "yes" or "no") if "no" provide address: THE PEOPLE OF THE STATE OF NEW YORK TO 3. _______________________________________________________________________ Number and Street City State Zip code Name and address of applicant if any other than the issuer. _______________________________________________________________________ GREETINGS: 4. Name and address of person to whom correspondence regarding this application should WE be addressed.YOU, that all business and excuses being laid aside, you and each of you attend before COMMAND , the Honorable at the Court _______________________________________________________________________ located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed 5. State whether issuer is a corporation, partnership, trust or or adjourned date, to testify and give evidence as a witness in this actionother entity and the State of on the part of the incorporation or jurisdiction under which organized. _______________________________________________________________________ 6. Your failure to comply with thiseach class is punishablebeingcontempt of court and will make you liable to Title and CUSIP number of subpoena or securities as a qualified, e.g., $10 par value the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a common stock, CUSIP 123. result of your failure to comply. _______________________________________________________________________ Witness, Honorable , one of the Justices of the (Instructions: All of the foregoing information should appear on and be the only information Court appearing on theCounty,page of theof in day application.) , 20 facing INSTRUCTIONS Completion of Application. The application should continue in the number sequence shown below. Any item which is inapplicable should be listed by the number on the form, followed by the word "inapplicable." 7. Describe the business done by the issuer and its subsidiaries and the general development of such business during the last three years and indicate the intended development of the business in the immediate future. Indicate any other names under which the issuer or any of its subsidiaries have conducted business during such period. List the names and home addresses of all the directors and officers of the issuer, indicating all positions and offices held by each person named. In addition, describe any order, judgment, or decree of any governmental agency or administrator, or of any court of competent jurisdiction, revoking or suspending for cause any license, permit or other Telephone No.: authority of such person or any corporation of which he is anNo.: or director, to engage Facsimile officer (Attorney must sign above and type name below) Attorney(s) for 8. Office and P.O. Address E-Mail Address: Mobile Tel. No.: 260.131 (Rev 9/02) 1 American LegalNet, Inc. www.USCourtForms.com in the securities business or in the sale of a particular security or temporarily or permanently restraining or enjoining any such person or any corporation of which he is an officer or director from engaging in or continuing any conduct, practice, or employment in connection with the purchase or sale of securities, or convicting such person of any felony or misdemeanor involving a security or any aspect of the securities business or of theft or of any felony. 9. Furnish in tabular form information as to the direct remuneration paid by the issuer and its subsidiaries during the issuer's last fiscal year for service in all capacities to each director, officer, and principal holder of securities (as defined in item 11) whose aggregate direct remuneration during such year exceeded $60,000, and the aggregate remuneration paid to all officers, directors, and principal holders of securities as a group. State in tabular form the title and amount of securities called for by any options, warrants or rights, including the purchase price of the securities so called for and the expiration COURT dates of such COUNTY .OF. . . . . . . . . . .options. together. with.the.market. value .of the securities so called for as of . . . . . . . . . . .the latest practicable date.. .Such. statements .should include the foregoing information for ..... ... . . . .. .... .... : Index No. all options held by each officer or director of the issuer. Except for information required with respect to each officer or director, information with respect to option prices and : expiration dates may be furnished in ranges. Calendar No. 11. A. State in tabular form the voting securities of the issuer owned of record or beneficially : JUDICIAL SUBPOENA Plaintiff(s) by each person who owns of record or is known by the applicant to own beneficially more than 10% of the outstanding securities of any class of such voting securities. Such -against: statements should reflect the respective amounts and percentage owned either beneficially or of record by each person and such statement should also include : information
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