Addendum To Business Organization And Registration Forms {SRA} | | New Hampshire

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Addendum To Business Organization And Registration Forms {SRA} |  | New Hampshire

Addendum To Business Organization And Registration Forms {SRA}

This is a New Hampshire form that can be used for General Business within Secretary Of State.

Alternate TextLast updated: 9/15/2006

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Form SRA Addendum to Business Organization and Registration Forms Statement of Compliance with New Hampshire Securities Laws Part I Business Identification and Contact Information Business Name: ___________________________________________________________________________________ Business Address (include city, state, zip): ______________________________________________________________ Telephone Number: (______) _________________________ E-mail:________________________________________ Contact Person:___________________________________________________________________________________ Contact Person Address (If Different):__________________________________________________________________ Part II Check ONE of the following items in Part II [PLEASE NOTE: Most small businesses registering in New Hampshire qualify for the exemption in Part II, Item 1 below. However, you must insure that your business meets all of the requirements spelled out in A), B), and C)]: 1. ____ Ownership interests in this business are exempt from the registration requirements of the state of New Hampshire because the business meets ALL of the following three requirements: A) This business has 10 or fewer owners; and B) Advertising relating to the sale of ownership interests has not been circulated; and C) Sales of ownership interests if any will be completed within 60 days of the formation of this business. 2. ____ This business will offer securities in New Hampshire under another exemption from registration or will notice file for federal covered securities. Enter the citation for the exemption or notice filing claimed - ___________________. 3. ____ This business has registered or will register its securities for sale in New Hampshire. Enter the date the registration statement was or will be filed with the Bureau of Securities Regulation - _____________. 4. ____ This business was formed in a state other than New Hampshire and will not offer or sell securities in New Hampshire. Part III Check ONE of the following items in Part III: 1. ____ This business is not a New Hampshire corporation or limited partnership. 2. ____ This business is a New Hampshire corporation or limited partnership and the articles of incorporation or certificate of limited partnership states whether capital stock, memberships, or interests will be sold or offered for sale. Part IV Certification of Accuracy (NOTE: The information in Part IV must be certified by: 1) all of the incorporators of a corporation to be formed; or 2) an executive officer of an existing corporation; or 3) all of the general partners or intended general partners of a limited partnership; or 4) one or more authorized members or managers of a limited liability company; or 5) one or more authorized partners of a registered limited liability partnership or foreign registered limited liability partnership.) I (We) certify that the information provided in this form is true and complete. (Original signatures only) Name (print): _________________________________ Signature: __________________________________ Name (print): _________________________________ Signature: __________________________________ Name (print): _________________________________ Signature: __________________________________ Date: _____________________ <<<<<<<<<********>>>>>>>>>>>>> 2 Instructions for Form SRA Addendum to Business Organization and Registration Forms Statement of Compliance with New Hampshire Securities Laws This form is required for all businesses being formed or registering in the state of New Hampshire. New Hampshire law requires that before your application for business registration is accepted, you must provide a statement that your business has complied with the states securities law. A security is an ownership interest in a business. For example, a share of stock is a security and so is an interest in a limited liability company or a limited partnership. So, for example, if you and your wife own the sole interests in a limited liability compa ny, those interests are securities. Generally, a business that issues securities in New Hampshire must either register the securities with the New Hampshire Bureau of Securities Regulation or claim a valid exemption. There are several exemptions from the requirement to register securities. The most common exemption is the exemption described in Part II, Item 1. Please read the following instructions for each part of Form SRA. These instruction will help you to provide accurate responses. Part I: Please provide the business name and address, including number, street, city, state and zip code. In addition, please provide the businesses telephone number, e-mail address if any a contact person name and the contact persons full address if different from the business address. Part II: Check only ONE item in this part. 1. Your business is qualified for the exemption from registration in Item 1 if it meets ALL of the requirement listed in A), B), and C) below: A) The business has 10 or fewer owners. So, for example, if you and your wi fe are forming a limited liability company and there are no other owners, you meet this requirement for an exemption; AND B) Advertising relating to the sale of ownership interests in your business has not been circulated. Please note that this requirement asks whether you have circulated adver tising related to the offer or sale of ownership interests. This requirement does not address advertising related to the sale of your products or services. So, for example, if you advertise that you ar e selling shares of stock in your corporation, then do not met this requirement and cannot claim the exemption; AND C) Sales of ownership interests if any will be completed within 60 days of the formation of the business. If you do not intend to sell any further ownership interests i n your business, then you meet this requirement for an exemption. If you intend to sell more ownership interests in your business and will complete all sales within 60 days, then you meet this requirement. However, if the sale of any ownership interests will occur within more than 60 days of the formation of the business, you do not meet this requirement and cannot claim the exemption. If you meet all of these requirements, you may then check off Item 1 and claim this exemption. 2. If you can claim a different registration exemption from the one listed in Item 1 or if you are offering federal covered securities that only require a notice filing in New

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