Form 27u - Notice Of Claim Of Exemption Under Section 58-13b-27u, Nmsa 1978 - State Of New Mexico

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(Rev. 11/98)
FORM 27-U NOTICE OF CLAIM OF EXEMPTION
UNDER SECTION 58-13B-27U, NMSA 1978
TO:
DIRECTOR, SECURITIES DIVISION
STATE OF NEW MEXICO
Notice is hereby given that the undersigned Company (corporation, limited partnership, limited liability
company or limited liability partnership) and claiming the exemption afforded by Section 58-13B-27U,
NMSA 1978, intends to avail itself of said exemption with respect to offers and sales of its securities as
hereinafter set forth. In support therefore, it submits the following information and exhibits:
I.
GENERAL INFORMATION
A.
Name and mailing address of Company.
B.
Type of entity (corporation, limited partnership, limited liability company, limited liability
partnership or other).
C.
Date and place of creation (incorporation, organization, filing or date of partnership
agreement).
D.
Term of entity (if applicable).
E.
Purpose or investment objective of business.
F.
Address where books and records, stock certificates or capital accounts are kept and by
whom.
II.
LIMITATION ON NUMBER OF PURCHASERS
A.
Estimated number of persons to whom offers will be made in the State of New Mexico.
B.
Number of current security holders in the State of New Mexico.
C.
Date(s) securities acquired by security holders in the State of New Mexico.
D.
Total number of securities holders in and out of State of New Mexico.
E.
Date of issuer’s last sale of securities.

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