Notice Of Issuance Of Securities Pursuant To Subdivision (O) Of Section 25102 Of The Corporations Code - Department Of Corporations
ADVERTISEMENT
1(Department of Corporations
DEPARTMENT OF CORPORATIONS
Use Only)
FILE No., if any:
Fee Paid $ ___________________
______________________________
(Insert File Numbers(s) of Previous
Receipt No. __________________
Filings Before the Department, If Any)
FEE: $______________
(See Corporations Code Section 25608(y) and Section 25608(e).
The fee is based on the current market value of the securities, or in the case of options, the underlying securities.)
COMMISSIONER OF CORPORATIONS
STATE OF CALIFORNIA
Notice of Issuance of Securities Pursuant to Subdivision (o) of Section 25102 of the Corporations Code
1.
Name of Issuer: _________________________________________________________________
2.
State of Incorporation or Organization: _______________________________________________
3.
Address of Principal Place of Business:
_______________________________________________________________________________
Number and Street
City
State
Zip Code
4.
The security is issued pursuant to a: (Check One)
[ ]
Purchase Plan or Agreement.
Name of Security: ______________________________________________________________
Number of Securities: ___________________________________________________________
Price Per Security: $____________________________________________________________
[ ]
Option Plan or Agreement.
Name and Number of Options: ____________________________________________________
Name and Number of the Underlying Securities: ______________________________________
_____________________________________________________________________________
Exercise Price Per Security: $_____________________________________________________
[ ]
"Flexible" Purchase/Option Plan or Agreement.
Name of Security/Option: ________________________________________________________
Number of Securities/Options: ____________________________________________________
Name and Number of the Underlying Securities: ______________________________________
Price Per Security: $_______________ ____________________________________________
5.
Aggregate current market value of securities sought to be sold: __ ________________________
6.
Date of Notice: ___________________
( )
Check if Issuer has
___________________________________
a consent to service of process
Name of Issuer
on file with the Commissioner
______________________________________
Authorized Signature on Behalf of Issuer
______________________________________
Print Name and Title of Signatory
Name, Address and Phone Number of Contact Person:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Instructions: Each issuer (other than a California corporation) filing a notice under Section 25102(o) must file
a consent to service of process (Form 260.165), unless it already has a consent to service on file with the Commissioner.
25102 (o) Rev. 05-01
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form 9 - Application To Register By Qualification Securities Pursuant To Section 1707.09 Of The Revised Code Of Ohio - Ohio Dept. Of Commerce
Financial
Form 144 - Notice Of Proposed Sale Of Securities Pursuant To Rule 144 Under The Securities Act Of 1933
Legal
Request For Designation As An Exempt Organization Pursuant To Subdivision Form - State Of California Department Of Corporations
Legal
Form D-1 - Notice Of Sale Of Securities Pursuant To The Delaware Limited Offering Exemption Form - State Of Delaware
Legal
Arizona Form 5012 - Certificate To Establish Residency In A Foreign Country Pursuant To A.r.s. Section Mark 42-5009(i)
Financial
Related Categories
Parent category: Legal