Nonprofit Issuer Registration Document And Disclosure Checklist Form
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4Division of Securities and Business Regulation
237 Coliseum Drive
Macon, Georgia 31217‐3858
(478) 207‐2440 * FAX (478) 314‐5805
Email: securities@sos.state.ga.us
BRIAN P. KEMP
NONPROFIT ISSUER REGISTRATION
COMMISSIONER OF SECURITIES
Document and Disclosure Checklist
Georgia Uniform Securities Act of 2008
O.C.G.A. § 10‐5‐23
Office Use ONLY
Control #:_______________
APPLICANT:
Examiner: ______________
Description of Document/ Disclosure
1. APPLICATION FOR REGISTRATION
A. Complete all applicable parts of application (Form 8)
B. Document and Disclosure Checklist
Manual Signatures of Officers and Directors
C.
(Note: All
Trustees, Directors, etc. MUST sign or give a separate letter of consent. A majority of
directors must sign Form 8.)
2. 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 (Form 6)
F. Corporate Resolution Authorizing Consent to Issue
Securities (Form 6A)
G. Date and Place Organized
3. DESCRIPTION OF OFFERING
A. Type of Securities
B. Number Offered
C. Offering Price and How Computed
D. Aggregate Offering
E. General Purpose of Offering
F. Specific Use of Proceeds
G. Commissions, Discounts and Expenses of Offering
4. ESCROW:
MANUALLY SIGNED copy of required escrow
agreement.
Rev. 2/2011
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