Notice Of Exchange Transaction Pursuant To Corporations Code Section 25103(H) - Department Of Corporations Page 2

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Name, Address and Phone Number of Contact Person:
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Instructions:
Each Acquiring Entity (other than a
California corporation) filing a notice under Section
25103(h) must file a consent to service of process (Form
260.165), unless it already has a consent to service on file
with the Commissioner.

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