Texas Crowdfunding Portal Registration {133.15} | Pdf Fpdf Docx | Texas

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Texas Crowdfunding Portal Registration {133.15} | Pdf Fpdf Docx | Texas

Texas Crowdfunding Portal Registration {133.15}

This is a Texas form that can be used for State Securities Board within Secretary Of State, Blue Sky.

Alternate TextLast updated: 9/20/2018

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Form 133.15 Texas State Securities BoardP.O. Box 13167Austin, Texas 78711-3167Texas Crowdfunding Portal Registration (247115.19)Notice: This form is for use in filing an original application for registration as a Texas crowdfunding portalthat acts as an intermediary in a transaction pursuant to 247139.25, relating to the Intrastate CrowdfundingExemption, and/or 247139.26, relating to Intrastate Crowdfunding Exemption for SEC Rule 147A Offerings,and to file amendments and supplementary information with the Securities Commissioner as necessary tokeep this form current. Any material change to the information or responses to questions herein must beupdated within 30 days of the change by filing an amendment with the Securities Commissioner.G ApplicationG AmendmentG Schedule AG Schedule BG Schedule C1.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 1A: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: Direct Telephone Number: 06--2018 American LegalNet, Inc. www.FormsWorkFlow.com Form 133.15 2.Form of Organization. Indicate the legal status of Applicant.G Texas CorporationG Texas PartnershipG Texas Limited Liability CompanyG Other (specify): Date of Formation:3.Successions. Is the Applicant at the time of this filing succeeding to the business of a currently-registered Applicant? If yes, provide name of acquired Applicant:4.Owners, Officers, Directors and Control Persons. If this is an initial application, the Applicant mustcomplete Schedule A providing information about these persons. If this is an amendment to updateinformation previously filed on Schedule A, Schedule B must be completed.5.Disclosure Information. Provide information about the Applicant222s disciplinary history and thedisciplinary history for any person listed on Schedule A or B. One event may result in the requirementto 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.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?GG 06--2018 American LegalNet, Inc. www.FormsWorkFlow.com Form 133.15 3.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?GG5.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 G 06--2018 American LegalNet, Inc. www.FormsWorkFlow.com Form 133.15 4.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 Schedule A or B by a state or foreign financial regulatory authority?GG4.Is the Applicant or any person on Schedule A or B now the subject of any civilproceeding that could result in a 223yes224 answer to any part of Items 5.E.1, 5.E.2, or5.E.3?GG5.Is the Applicant or any person on Schedule A or B currently the subject of anyunsatisfied judgments or liens?GG5.F.Has the Applicant or any person on Schedule A or B ever had an authorization to actas an attorney, accountant, or state or federal contractor revoked or suspended? YesNoGG6.Non-Securities Related Business. Does the Applicant engage in any non-securitiesrelated business?YesNoGGIf 223yes,224 briefly describe the non-securities business: 06--2018 American LegalNet, Inc. www.FormsWorkFlow.com Form 133.15 EXECUTIONThe undersigned hereby represents that he/she has executed this form on behalf of the Applicant and that theinformation contained herein and other informatio

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