Annual Report Form (Intrastate) - New York State Department Of Law

ADVERTISEMENT

INTRASTATE 6
NY #________________
ANNUAL REPORT (INTRASTATE)
TO BE SUBMITTED PURSUANT TO SECTION 80.15 OF THE INTRASTATE FINANCING ACT
REGULATIONS WITHIN FOUR (4) AFTER THE CLOSE OF THE FISCAL YEAR.
1. Name of Issuer: _______________________________________________________
2. Address:_____________________________________________________________
3. Period covered by report: From ____________________ to___________________ __
4. Is there attached, as required, a Balance Sheet and a Profit and Loss Statement?
Yes [ ] No [ ]
Does such statement include an express opinion as to fairness of presentation and consistency of the
data, by an independent public accountant? Yes [ ] No [ ]
If not, has an exemption been obtained under Regulation 80.15(d)? Yes [ ] No [ ]
by letter dated__________________________.
5. Is there attached, as required, a narrative report setting forth the material events of the period covered
by the report? Yes [ ] No [ ]
6. Is there attached, a statement setting forth in detail the use of all proceeds obtained as a result of any
offering or issue of securities or from any refinancing, or indicating that no such funds were obtained?
Yes [ ] No [ ]
No such funds obtained during period. [ ]
[If any such funds were obtained, show accounting details including amount credited to capital accounts,
surplus, long-term debt, notes payable, etc. on a separate sheet, attached.]
7A. Is there attached, as required, a statement setting forth the names and addresses of, and the
compensation and other transactions with, all officers and directors or general partners or principals, of
the issuer? Yes [ ] No [ ]
B. During the period covered by this report, did any principal, partner, officer of director sell or
otherwise dispose of or hypothecate any of the issuer's securities or were any loans or advances made by
the issuer to such persons? Yes [ ] No [ ]
8. Has the issuer submitted, as required, to all owners of the issuer's securities, an annual report
containing the item stated under 4, 5, 6 and 7? Yes [ ] No [ ]

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 2