Form 133.29 - Intrastate Exemption Notice Page 3
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133.29
estate, franchises, business opportunities, consumer goods, or other goods and
services.
No
Yes
If yes, give details in an attached statement, including pertinent dates,
style and number of case, and disposition of case.
(b)
has been convicted within 5 years prior to commencement of the offering:
(1)
of any felony or misdemeanor of which fraud is an essential element, or which is
a violation of the securities laws or regulations of this state, any other state of the
United States, the United States, or any foreign jurisdiction;
(2)
of a crime involving moral turpitude; or
(3)
of a criminal violation of statutes designed to protect consumers against unlawful
practices involving insurance, securities, commodities or commodity futures, real
estate, franchises, business opportunities, consumer goods or other goods and
services.
No
Yes
If yes, give details in an attached statement, including identification
of court, style and number of case, charge, and disposition of case.
(c)
is subject to any order, judgment or decree entered within 5 years prior to
commencement of the offering by any court of competent jurisdiction which:
(1)
temporarily or permanently restrains or enjoins such person from engaging in or
continuing any conduct or practice in connection with the purchase or sale of any
security or involving any false filing with any state; or
(2)
restrains or enjoins such person from activities governed by federal or state
statutes designed to protect consumers against unlawful or deceptive practices
involving insurance, commodities or commodity futures, real estate, franchises,
business opportunities, consumer goods, or other goods and services.
If yes, give details in an attached statement, including identification of
No
Yes
court, style and number of case, and disposition of case.
STATE OF
COUNTY OF
The undersigned being duly sworn deposes and says that he or she has executed the foregoing
application for and on behalf of the issuer named therein; that he or she is the
of such issuer and is fully authorized to execute and file such application; that he or she is familiar
08-16-2010
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