Notice Of Transaction Pursuant To Corporations Code Section 25102(F) Form - State Of California - Commissioner Of Corporations
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1.
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(Department of Corporation Use Only)
DEPARTMENT OF CORPORATIONS FILE NO, if any:
Fee Paid $______________________
______________________________________________
Receipt No. ____________________
Insert File number(s) of Previous filings
Before the Department if any.
FEE: $25.00 $35.00 $50.00 $150.00 $300.00
Circle the appropriate amount of fee. Corporations Code Section 25608(c).
COMMISSIONER OF CORPORATIONS
STATE OF CALIFORNIA
NOTICE OF TRANSACTION PURSUANT TO CORPORATIONS CODE SECTION 25102(f)
A.
Check One:
Transaction under
( ) Section 25102(f)
( ) Rule 260.103
1.
Name of Issuer:_______________________________________________________________________________________
2.
Address of Issuer:_____________________________________________________________________________________
Street
City
State
Zip
Mailing Address:______________________________________________________________________________________
Street
City
State
Zip
3.
Area Code and Telephone Number:_______________________________________________________________________
Issuer’s state (or other jurisdiction) of incorporation or organization:_____________________________________________
4.
5.
Title of class or classes of securities sold in transaction:_______________________________________________________
___________________________________________________________________________________________________
6.
The value of the securities sold or proposed to be sold in the transaction, determined in accordane with Corporation Code
Sec. 25608(g) in connection with the fee required upon filing this notice, is (fee based on amount shown in line (iii) under
Total Offering):
California
Total offering
(a) (i)
In money
$________________________
$________________________
(ii)
In consideration other than money
$________________________
$________________________
(iii)
Total of (i) and (ii)
$________________________
$________________________
(b)
(___) Change in rights, preferences, privileges or restrictions of or on outstanding securities.
( $25.00 fee) (See rule 260.103.)
7.
Tye of filing under securities Act of 1933, if applicable:_______________________________________________________
____________________________________________________________________________________________________
8.
Date of Notice:___________________
__________________________________________
Issuer
(___)
Check if issuer already has a consent to service of process on file with the commissioner
__________________________________________________
Authorized Signature on behalf of issuer
__________________________________________________
Print name and title of singatory
Name, Address and Phone number of contact person:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
.
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