Form 8-Nr Rescission Notice And Notification Form Georgia Securities Act Of 1973

SECURITIES AND BUSINESS REGULATION

2 Martin Luther King, Jr. Drive, S.E.

Ste 802, West Tower Atlanta, Georgia 30334

(404) 656-3920

KAREN HANDEL

ROBERT D. TERRY

Commissioner of Securities

Assistant Commissioner of Securities

RESCISSION NOTICE AND NOTIFICATION FORM

Georgia Securities Act of 1973, as amended

O.C.G.A. § 10-5-5(c)(1)(P)

INSERT THE FOLLOWING NOTICE OF RESCISSION on the inside front cover page of the prospectus in the case

of a printed prospectus or on the second page of the prospectus in the case of a prospectus reproduced by any other means,

in boldfaced print or CAPITAL type:

ANY PERSON WHO PURCHASES THE SECURITIES OFFERED HEREBY SHALL HAVE

THE UNQUALIFIED AND UNWAIVABLE RIGHT TO RESCIND SUCH PURCHASE

WITHIN 72 HOURS OF THE EXECUTION OF A WRITTEN AGREEMENT TO PURCHASE ANY SECURITIES

OFFERED HEREBY, THE DELIVERY OF A CONFIRMATION OF SALE, OR THE PAYMENT FOR ANY

SECURITIES OFFERED HEREBY, WHICHEVER SHALL OCCUR FIRST.

RESCISSION MAY BE ACCOMPLISHED BY COMPLETING AND

MAILING THE FORM PROVIDED ON PAGE ______ OF THIS PROSPECTUS.

INSERT THE FOLLOWING NOTIFICATION OF RESCISSION on the inside back cover page in the case of a

printed prospectus or the final page in the case of a prospectus reproduced by any other means, to provide a means of

exercising the right of rescission provided in section 10-5-5(c) (1) (P) of the Georgia Securities Act of 1973, as amended.

Separate forms are required, addressed to both the issuer and the Commissioner of Securities.

NOTICE OF RESCISSION

TO: COMMISSIONER OF SECURITIES

OFFICE OF THE SECRETARY OF STATE

2 MARTIN LUTHER KING, JR. DR., S.E.

SUITE 802, WEST TOWER

ATLANTA, GA 30334

I hereby exercise my right to rescind my purchase of ____________shares of the________________________________.

__________________________________________

(Name of Issuer/Company)

This rescission is made within seventy-two (72) hours of the earliest of my execution of a written agreement to purchase

said shares, the delivery of a confirmation of sale of said shares to me or the payment for such shares, the delivery of a

confirmation of sale of said shares to me or the payment for such shares. I understand that the effective date of the

rescission shall be the date of delivery of this Notice or the depositing of same, properly addressed with adequate postage

thereon, in the United States Mail.

DATED, this _______________day of __________________________, 20___

SIGNATURE ____________________________________________________________________________

NAME ____________________________________________________________________________

ADDRESS _________________________________________________________________________

CITY ______________________________________ STATE ____________ ZIP CODE ___________

Form 8-NR

Rev. June 2007

Form 8-Nr Rescission Notice And Notification Form Georgia Securities Act Of 1973 - 2007

Related Articles

Related forms

Related Categories