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Issuer Exemption Final Report Of Sales E(R)(S) - North Dakota
| Issuer Exemption Final Report Of Sales Form. This is a North Dakota form and can be used in Securities Blue Sky Secretary Of State . |
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ISSUER EXEMPTION FINAL REPORT OF SALES NORTH DAKOTA SECURITIES DEPARTMENT SFN 51954 (8-2011) FORM E (R) (S) Securities Department 600 E Boulevard Ave Dept 414 Bismarck ND 58505 (701) 328-2910 www.ndsecurities.com REPORT OF SALES OF SECURITIES PURSUANT TO THE NORTH DAKOTA ISSUER EXEMPTION UNDER SECTION 10-04-06 (9) (B) OF THE NORTH DAKOTA CENTURY CODE INSTRUCTIONS: A report of sales must be filed within 30 days after the completion of the offering or expiration of the twelve-month approval period, whichever occurs first. CAVEAT: Intentional misstatements or omissions of material facts constitute criminal violations. (See Sections 10-40-15(1) and 10-04-18 of the North Dakota Century Code.) 1. Name of Issuer: Address of Issuer: (Street) City: State: Zip Code: 2. Title or Class of Securities Sold: 3. Dollar Amount of Securities Sold in North Dakota: 4. Number of Buyers to Whom Securities were Sold in North Dakota: 5. State each purpose and the amount for each purpose for which the proceeds of this offering have been or will be used. 6. State the names of any dealers, salesmen, finders, or other persons who acted on behalf of the issuer in making offers or sales: This report is filed by the issuer, through its duly authorized agent, whose signature appears below. Issuer: Date of Report: Signature of Authorized Agent or Officer: American LegalNet, Inc. www.FormsWorkFlow.com
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