Department Of Corporation Use Only Form (Page 3 of 3) in pdf

Department Of Corporation Use Only Form Page 3

Signing of Application. Application should be signed by an officer or general partner of the applicant; however, it

may be signed by another person holding a power of attorney for such purposes from the applicant, and if signed on

behalf of the applicant pursuant to such power of attorney, should include as an additional exhibit a copy of said power of

attorney or a copy of the corporate resolution authorizing the attorney to act.

Incorporation by Reference. In lieu of answering any specific item in this form, an applicant may incorporate the

information called for by reference to any attached document, or to any document currently on file with the Department.

Such reference should indicate the pages or portion of the document where the information is located.

Filing Fee. The filing fee shall be the amount that would have been payable under subdivisions (e), (f), (h) or (i) of

Section 25608 if an application had been filed to qualify the transaction in which the securities were sold in violation of the

qualification provisions. The filing fee fixed by Section 25608 must accompany each application and the amount of filing

fee paid is to be set forth on the front page in the upper right hand corner.

By way of illustration, the filing fee for qualification of securities by coordination, notification, or permit, under

Sections 25113 or 25121 is computed by taking 2/10ths of 1% of the maximum aggregate offering price of securities

being qualified in California and adding $200. Thus, a qualification for $275,250 would be computed by moving the

decimal point three places to the left, $275.25, doubling the amount, $550.50, and adding $200 for a total of $750.50.

Department Of Corporation Use Only Form Page 3