Ny Form 99 - Notification Filing
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4OFFICE OF ATTORNEY GENERAL ERIC T. SCHNEIDERMAN
File #
STATE OF NEW YORK DEPARTMENT OF LAW
NY FORM 99
I
NVESTOR PROTECTION BUREAU / REAL ESTATE FINANCE BUREAU
NOTIFICATION FILING
Submission to:
☐ INVESTOR PROTECTION BUREAU (“IPB”)
☐ Securities ☐ Theatrical Syndications
□ REAL ESTATE FINANCE BUREAU (“REF”)
☐ New Filing
Type of Filing:
□ Amendment or Renewal (If name, address or offering has changed, indicate change and date):
A. BASIC IDENTIFICATION DATA
Full Name of Issuer (and Theatrical Production Company, if applicable):
Address of Executive Offices:
Telephone Number (
)
-
(Number and Street)
(City or Town)
(State & ZIP)
☐business corporation
☐limited liability company
☐limited partnership
Type of Organization:
☐not-for-profit corporation
☐business trust
☐political subdivision of state ☐ common fund
☐state agency or authority
☐county, city, town or village (☐agency, authority or instrumentality corporation)
☐other (specify):
Category of “Covered Security”:
□ Offering to “Qualified Purchasers” [1933 Act* §18(b)(3)]
□ Rule 506 Offering [1933 Act* § 4(2) - per §18(b)(4)(D)]
□ Regulation A, Tier 2 Offering [1933 Act* §3(b)(2) - per §§ 18(b)(3) & 18(b)(4)(D)(ii)]
□ Other qualifying offering (specify):
* Securities Act of 1933, as amended
☐ officers or directors of issuer
☐ salespersons employed by issuer
The Securities Will Be Sold By:
□ officers or directors of an affiliated person
☐ underwriter, dealer or broker registered in New York
For Theatrical Syndication Offerings, add the following information:
Name of proposed production:
Location of production:
Proposed opening date:
)
IPB/REF099 - (rev. 7/2015
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