Form 260.100.3 - Request For Order Of Exemption (Page 3 of 3) in pdf

Form 260.100.3 - Request For Order Of Exemption Page 3

I certify (or declare) under penalty of perjury under the laws of the State of California that I have read this

request and the exhibits thereto and know the contents thereof, and that the statements therein are true and

correct.

Executed at____________________________________________ on____________________, 20_______

(Place)

(Date)

___________________________________

(Signature)

Instruction: It is recognized that if this is the Issuer's first request for Order of Exemption, some of the

information requested by this application may not be available to the Issuer. If any requested information is

not available, the Issuer shall so state and explain why the information is not available. The Commissioner

expects that all Issuers who intend to apply for this Order of Exemption on a continuous basis will take

appropriate action subsequent to the initial request to obtain information that was unavailable for this request

for submission in subsequent requests for Order of Exemption pursuant to Section 25100(l).

260.100.3 (Rev. 9/02)

Form 260.100.3 - Request For Order Of Exemption Page 3