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Notice Of Transaction Pursuant To Corporations Code Section 25102(f) 25102(F) - California
| Notice Of Transaction Pursuant To Corporations Code Section 25102(f) 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) DEPARTMENT OF CORPORATIONS FILE NO., if any: Fee paid $________________ ________________________ Receipt No. ______________ ___________________________________________ ___________________________________________ Insert File number(s) of Previous Filings Before the Department, if any. Fee: $25.00 $35.00 $50.00 $150.00 $300.00 (Circle the appropriate amount of fee. See Corporations Code Section 25608(c)) COMMISSIONER OF CORPORATIONS STATE OF CALIFORNIA NOTICE OF TRANSACTION PURSUANT TO CORPORATIONS CODE SECTION 25102(f) A. Check one: Transaction under ( ) Section 25102(f) ( ) Rule 260.103. ELECTRONIC FILING REQUIREMENT AND HARDSHIP EXCEPTION: This notice must be filed electronically through the Internet process made available by the Department of Corporations at www.corp.ca.gov, unless the issuer claims the hardship exception as described in Number 8 below. 1. Name of Issuer: ____________________________________________________________________________________ 2. Address of Issuer: ____________________________________________________________________________________ Street City State Zip Mailing Address: ____________________________________________________________________________________ Street City State Zip 3. Area Code and Telephone Number: _______________________________________________________ 4. Issuer's state (or other jurisdiction) of incorporation or organization: ____________________________________________________________________________________ 5. Title of class or classes of securities sold in transaction: ____________________________________________________________________________________ ____________________________________________________________________________________ 6. The value of the securities sold or proposed to be sold in the transaction, determined in accordance with Corporations Code Sec. 25608(g) in connection with the fee required upon filing this notice, is (fee based on amount shown in line (iii) under "Total Offering"): California Total Offering (a)(i) in money $_____________ $_____________ (ii) in consideration other than money $_____________ $_____________ (iii) total of (i) and (ii) $_____________ $_____________ (b) ( ) Change in rights, preferences, privileges or restrictions of or on outstanding securities ($25.00 fee.) (See Rule 260.103.) 260.102.14(c) (Register 2009, No. 39) American LegalNet, Inc. www.FormsWorkFlow.com 7. Type of filing under Securities Act of 1933, if applicable: ____________________________________ ___________________________________________________________________________________ 8. Hardship Exception for electronic filing. An issuer may file this paper notice in person or by mail only if either of the following exceptions apply. The issuer shall check applicable box and include the reason(s) and description(s) for the hardship exception in the space provided. Computer equipment including hardware and software is unavailable to the issuer without unreasonable burden or expense. If this is the case, describe below both of the following; the reason(s) that the computer equipment including hardware and software is unavailable without unreasonable burden or expense, and the description(s) of the unreasonable burden or expense. The issuer cannot obtain and provide information (including credit card or other identifying information) requested on the Department's electronic notice or through the Internet filing process. If this is the case, describe below both of the following: the reason(s) that the issuer cannot obtain and provide the requested information on the electronic notice or through the Internet filing process without unreasonable burden or expense, and the description(s) of the unreasonable burden or expense to the issuer to make the electronic filing. After checking the applicable hardship exception above, the issuer shall describe below the reason(s) and description(s) for that hardship exception. (If additional space is needed, attach a separate sheet to this notice.) _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 9. ( ) Check if issuer already has a consent to service of process on file with the Commissioner. (Instruction: Each issuer (other than a California Corporation) filing a notice under Section 25102(f) must file a consent to service of process (Form 260.165), unless it already has a consent to service on file with the Commissioner. If no consent to service of process is on file with the Commissioner, attach the consent to this notice.) 10. ____________________________________ Authorized Signature on behalf of issuer ______________________________________ Print name and title of signatory _____________________________________ Date Name, Address and Phone number of contact person: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 260.102.14(c) (Registered 2009, No. 39) 2 American LegalNet, Inc. www.FormsWorkFlow.com (d) Instructions. The following instructions apply to the form specified in subsection (c): COMMISSIONER OF CORPORATIONS STATE OF CALIFORNIA NOTICE OF TRANSACTION PURSUANT TO CORPORATIONS CODE SECTION 25102(f) INSTRUCTIONS 1. This Notice is to provide information on transactions conducted under the section 25102(f) exemption from the qualification requirements of Section 25110 of the Corporate Securities Law of 1968 and under the Rule 260.103 exemption from the qualification requirements of Section 25120 of that Law. The form is not designed to indicate whether or not the transaction complies with the requirements of those exemptions but only to provide notice to the Commissioner that the exemption is being relied on. 2. When to File Notice. The Notice must be filed with, or mailed to, the Commissioner within 15 calendar days after the first sale of a security in the transaction in
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