Crowdfunding Portal Registration Small Business Development Entity {133.20} | Pdf Fpdf Docx | Texas

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Crowdfunding Portal Registration Small Business Development Entity {133.20} | Pdf Fpdf Docx | Texas

Last updated: 9/20/2018

Crowdfunding Portal Registration Small Business Development Entity {133.20}

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Form 133.20 Texas State Securities BoardP.O. Box 13167Austin, Texas 78711-3167Texas Crowdfunding Portal Registration by anAuthorized Small Business Development Entity(247115.20)Notice: This form is for use by an Authorized Small Business Development Entity in filing an originalapplication for registration as a Texas Crowdfunding Portal that acts as an intermediary in a transactionpursuant to 247139.25, relating to the Intrastate Crowdfunding Exemption, and/or 247139.26, relating to IntrastateCrowdfunding Exemption for SEC Rule 147A Offerings, and to file amendments and supplementaryinformation with the Securities Commissioner as necessary to keep this form current. Any material changeto the information or responses to questions herein must be updated within 30 days of the change by filingan amendment with the Securities Commissioner.G ApplicationG AmendmentG Schedule AG Schedule BG Schedule CG Schedule D1.Applicant information.A.Full name of the Applicant:B. IRS Employer Identification Number:C.Name(s) under which business is conducted, if different from Item 1.A:D.If this filing makes a name change on behalf of the Applicant, enter the new name: and specify whether the name change is of the G Applicant name (1.A) or G Business name (1.C).E.Applicant222s main address (do not use a P.O. Box): (Other business locations must be reported on Schedule C)F.Telephone Number: Website(s) URL: G.Contact employee: Email Address: Name and Title: 06-2018 American LegalNet, Inc. www.FormsWorkFlow.com Form 133.20 Direct Telephone Number: 2.Form of Organization. Indicate the legal status of Applicant.G Type A corporation authorized under Chapter 504, Local Government Code.G Type B corporation authorized under Chapter 505, Local Government Code.G Texas municipal corporation.G Texas Veterans Commission.G nonprofit organization authorized by an agency or authority of the federal government to distributehousing and community development block grants. Agency or authority authorizing the applicant:G nonprofit community development financial institution certified by the Community DevelopmentFinancial Institutions Fund. (Attach copy of the certification.)Date of Formation: 3.Successions. (To be completed if the Applicant is a nonprofit organization or nonprofit communitydevelopment financial institution.) Is the Applicant at the time of this filing succeeding to the businessof a currently-registered Applicant? If yes, provide name of acquired Applicant:4.Owners, Officers, Directors and Control Persons. (To be completed if the Applicant is a nonprofitorganization or nonprofit community development financial institution.) If this is an initial application,the Applicant must complete Schedule A providing information about these persons. If this is anamendment to update information previously filed on Schedule A, Schedule B must be completed.5.Disclosure Information. (To be completed if the Applicant is a nonprofit organization or nonprofitcommunity development financial institution.) Provide information about the Applicant222s disciplinaryhistory and the disciplinary history for any person listed on Schedule A or B. One event may result inthe requirement to answer 223yes224 to more than one of the questions below.If the answer is 223yes224 to a question in any part of Item 5, detailed information must be submitted as partof the application or amendment including:Criminal Actions: Docket/case number, whether felony or misdemeanor, jurisdiction where chargeswere brought, detailed description of the offense and circumstances leading to the charge, relevant dateswhen the conduct occurred that was the subject of the charge, disposition of the case, and date ofdisposition.Regulatory Actions and Self-Regulatory Organization Actions: Docket/case number, filing date ofaction, agency/organization initiating regulatory action, sanctions, date of sanctions, detailed descriptionof the case and circumstances leading to the action, relevant dates when the conduct occurred that wasthe subject of the action, disposition of the case, and date of disposition. 06-2018 American LegalNet, Inc. www.FormsWorkFlow.com Form 133.20 Civil Judicial Actions: Docket/case number, filing date of court action, detailed description of the caseand circumstances leading to the litigation, current status, resolution date, detailed description of theresolution and sanctions.5.A.Criminal Actions. Check all that apply.YesNo1.In the past 10 years has the Applicant or any person on Schedule A or B been convictedof any felony, or pled guilty or nolo contendere (223no contest224) to any charge of afelony, in a domestic, foreign, or military court?GG2.Is the Applicant or any person on Schedule A or B currently charged with any felonyin a domestic, foreign, or military court?GG3.In the past 10 years has the Applicant or any person on Schedule A or B been convictedof any misdemeanor, or pled guilty or nolo contendere (223no contest224), in a domestic,foreign, or military court to any charge of a misdemeanor in a case involvinginvestment-related business, fraud, false statements, omissions, wrongful taking ofproperty, bribery, perjury, forgery, counterfeiting, extortion, or a conspiracy to commitany of these offenses?GG4.Is the Applicant or any person on Schedule A or B currently charged with anymisdemeanor in a domestic, foreign, or military court involving investment-relatedbusiness, fraud, false statements, omissions, wrongful taking of property, bribery,perjury, forgery, counterfeiting, extortion, or a conspiracy to commit any of theseoffenses?GG5.B.Regulatory Actions. Check all that apply. Has any state, federal, or foreign financialregulatory authority ever:YesNo1.found the Applicant or any person on Schedule A or B to have made a false statementor omission, or been dishonest, unfair, or unethical?GG2.found the Applicant or any person on Schedule A or B to have been involved in aviolation of any regulation or statute?GG3.found the Applicant or any person on Schedule A or B to have been a cause of thedenial, suspension, revocation, or restriction of the authorization of aninvestment-related business to operate?GG4.entered an order against the Applicant or any person on Schedule A or B in connectionwith investment-related activity?GG5.imposed a civil money penalty on the Applicant or any person on Schedule A or B, orordered the Applicant or any person on Schedule A or B to cease and desist from anyactivity?GG6.denied, suspended, or revoked the registration or license of the Applicant or any personon Schedule A or B, or otherwise restricted the activities of the Applicant or any personon Schedule A or B?GG 06-2018 American LegalNet, Inc. www.FormsWorkFlow.com Form 133.20 5.C.Self-Regulatory Organization Actions. Check all that apply. Has any self-regulatoryorganization ever: YesNo1.found the Applicant or any person on Schedule A or B to have made a false statementor omission?G G2.found the Applicant or any person on Schedule A or B to have been involved in aviolation of its rules?G G3.found the Applicant or any person on Schedule A or B to have been the cause of adenial, suspension, revocation, or restriction of the authorization of aninvestment-related business to operate?G G4.disciplined the Applicant or any person on Schedule A or B by expelling, suspending,or otherwise restricting the activities of the Applicant or any person on Schedule A orB?GG5.D. Is the Applicant or any person on Schedule A or B currently the subject of anyproceeding that could result in a 223yes224 answer to any part of Item 5.B or 5.C?YesNoGG5.E.Civil Judicial Actions. Check all that apply.YesNo1.In the past 10 years has any domestic or foreign court enjoined the Applicant or anyperson on Schedule A or B in connection with any investment-related activity?GG2.In the past 10 years has any domestic or foreign court ever found that the Applicant orany person on Schedule A or B was involved in a violation of investment-relatedstatutes or regulations?GG3.In the past 10 years has any domestic or foreign court ever dismissed, pursuant to asettlement agreement, an investment-related civil action brought against the Applicantor any person on

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