Form 133.29 - Intrastate Exemption Notice Page 2
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133.29
(b)
Total number of shares or units proposed to be sold:
(c)
Offering price per unit at which the securities are to be sold:
(d)
Aggregate dollar amount of securities to be sold:
3. Section 35 of the Texas Securities Act requires payment of a fee that is equal to one-tenth of
one percent (1/10 of 1%) of the aggregate amount of securities described as being offered for
sale, but in no case more than $500. Please indicate the amount of fees remitted.
4. List present officers, directors, partners, members, trustees or managers. Give complete
names, dates of birth, home addresses, and business addresses:
5. List all persons who will actually engage in selling securities. Give complete names, dates
of birth, and addresses:
6. State whether the issuer or the registered dealer (as such terms are defined in §109.13(l)):
(a)
is currently subject to any administrative order issued by state or federal authorities
within 5 years of the expected offer and sale of securities in reliance upon this
exemption, and the order:
(1)
is based upon a finding that such person has engaged in fraudulent conduct; or
(2)
has the effect of enjoining such person from activities governed by federal or state
statutes designed to protect investors or consumers against unlawful or deceptive
practices involving securities, insurance, commodities or commodity futures, real
08-16-2010
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