Form 8q - Registration By Qualification

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SECURITIES AND BUSINESS REGULATION
237 Coliseum Drive
Macon, Georgia 31217-3858
(404) 656-3920
REGISTRATION BY QUALIFICATION
Document and Disclosure Checklist
Georgia Uniform Securities Act of 2008
O.C.G.A. 10-5-23
Official Use ONLY
Control #:_______________
Examiner:_______________
APPLICANT:_______________________________________
EMAIL:____________________________________________
LOCATION
Description of Document/Disclosure
O.C.G.A. 10-5-23
1.
ADVISORY DIRECTORS
A.
Written Consent
B.
Description of Relationship
C.
Compensation
2.
APPLICATION FOR REGISTRATION
A.
Complete All Applicable Parts of Form 8
B.
Document and Disclosure Checklist
C.
Manual Signatures of Officers and Directors
3.
BOND/FINANCIAL RESPONSIBILITY
A.
Bond -- $25,000
B.
Certificate of Deposit -- $25,000
C.
Other
4.
CAPITALIZATION
A.
Within 90 Days
B.
Adjusted for Proposed Offering
C.
Statement of Consideration Received for Securities Issued in
the Past Two Years
5.
CORPORATE DOCUMENTS
A.
Articles of Incorporation
B.
Bylaws
C.
Management Contracts
D.
Indenture or Other Instrument Relating to the Securities to
be Registered
E.
Consent to Service of Process
F.
Corporate Resolution Authorizing Consent to Issue Securities
G.
Date and Place Organized
6.
COMPETITIVE CONDITIONS STATEMENT
7.
CONFIDENTIAL TREATEMENT REQUEST
8.
DESCRIPTION OF OFFERING
A.
Type of Securities
B.
Number Offered
C.
Offering Price and How Computed
D.
Aggregate Offering
Form 8Q Rev. 6/2010
1

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