(Department of Corporations 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.
1
COMMISSIONER OF CORPORATIONS
STATE OF CALIFORNIA
FIRST NOTICE OF TRANSACTION
PURSUANT TO CORPORATIONS CODE SECTION 25102(n)
Check One: ( ) Transaction under Section 25102(n)
( ) Transaction under Rule 260.103 with Notice pursuant to Section 25102(n)
FEE: $600.00 (For Section 25102(n) filings including transactions under Section 25102(n) and Rule 260.103)
See Corporations Code Section 25608(x)
1.
Name of Issuer: ______________________________________________________________________
2.
Address of Issuer: ____________________________________________________________________
Street
City
State ZIP
Mailing Address: _____________________________________________________________________
Street
City
State ZIP
3.
Area Code and Telephone Number: ______________________________________________________
4.
Incorporation or organization of the Issuer. Check one:
( )
Issuer is a California corporation.
( )
Issuer is a foreign corporation subject to Corporations Code Section 2115. Issuer's state (or
other jurisdiction) of incorporation or organization: ____________________________.
( )
Issuer is another form of business entity organized under the laws of California (specify):
_________________________________________________________________.
5.
Title of class or classes of securities to be sold in the transaction:
_________________________________________________________________________________
6.
Type of filing under Securities Act of 1933, if applicable: __________________________________
_________________________________________________________________________________
7.
Distribution of Disclosure Statements. Check one:
( )
Disclosure statements will be provided to each purchaser at least five business days before the
securities are sold to the purchaser; or
( )
Disclosure statements will not be provided based on the fact that all purchasers fall within Rule
206.102.13.
First Notice - Section 25102 (n) Revised 3/02