Form K Notice Of Claim Of Exemption Under Section 58-13b-27k, Nmsa 1978

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(Rev. 11/98)
FORM K NOTICE OF CLAIM OF EXEMPTION
UNDER SECTION 58-13B-27K, NMSA 1978
(To be completed by non-New Mexico entities only)
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-27K,
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.
G.
Estimated number of persons to whom offers will be made.
H.
Number of current security holders.
I.
Name and address of each person who will be effecting or attempting to effect sales of
securities.

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