Form Sc-610-009 - Notification Of Claim Exemption
Download a blank fillable Form Sc-610-009 - Notification Of Claim Exemption in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Sc-610-009 - Notification Of Claim Exemption with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2State of Washington
Department of Financial Institutions
Securities Division
NOTIFICATION OF CLAIM EXEMPTION
PO Box 9033
Olympia, WA 98507-9033
PURSUANT TO RCW 21.20.320(9), WAC 460-44A-504,
AND SECURITIES AND EXCHANGE COMMISSION RULE 147
(360) 902-8760
1. Name of Issuer
Phone Number
2. Form of Organization (check One)
Corporation
Unincorporated Association
Limited Partnership
Other Specify
Address of Issuer
4. Name (in full), address and telephone
NOTE:
If the controlling person, promoter, or
3. Type of Business (check one)
If corporation: chief executive officer
general partner is not a natural person,
Manufacturing
if unincorporated association: promoter or
provide similar information for a natura
Service
controlling person
person having primary responsibility to
Extractive
If partnership: general partner
the affairs of the issuer.
Real Estate
If other: controlling person
Other (specify)
Name (Notarized signature required on reverse side of this form.)
Position
Address
Phone Number
5. Issuer ’s state of incorporation or
or jurisdiction of organization.
Date of incorporation or organization
6. Title of class of securities
7. Total number of
8. Aggregate dollar
9. Price per share or
10. Total number of
to be sold in this offering
shares or units of
amount of the offering.
unit of securities to be
purchasers other than
securities to be sold in
sold.
accredited investors to
this offering.
whom securities are to
be sold.
11. Past securities sales. List all securities sole by the issuer within the 12 months preceding the filing of this form. (Continue of reverse side.)
Date of Sale
Description of Security
Amount
Basis on which securities were sold, i.e., Exemption or Registration under
Federal Securities Act of 1933 and Washington State Securities Act.
12.
FILING FEE ENCLOSED. Fifty Dollars ($50.00) to accompany Notification of Claim of Exemption
SC-610-009 (R/8/93)M Pag
e 1 of 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal