Statement Of Share And Equity Capital Exchange Form - Colorado Secretary Of State
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6Document processing fee
If document is filed on paper
$150.00
If document is filed electronically
Currently Not Available
Fees & forms/cover sheets
are subject to change.
To file electronically, access instructions
for this form/cover sheet and other
information or print copies of filed
documents, visit
and select Business.
Paper documents must be typewritten or machine printed.
ABOVE SPACE FOR OFFICE USE ONLY
Statement of Share and Equity Capital Exchange
filed pursuant to §7-90-301, et seq. and
§7-56-605
or
§7-111-105
Colorado Revised Statutes (C.R.S.)
1. Entity name or true name of each entity
the shares of which will be acquired:
______________________________________________________
(Enter name exactly as it appears in the records of the secretary of state if applicable)
ID number:
_____________________
Principal office street address:
______________________________________________________
(Street name and number)
______________________________________________________
__________________________ ____
____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
Principal office mailing address: ______________________________________________________
(if different from above)
(Street name and number or Post Office Box information)
______________________________________________________
__________________________ ____
____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
Entity name or true name:
______________________________________________________
(Enter name exactly as it appears in the records of the secretary of state if applicable)
ID number:
_____________________
Principal office street address:
______________________________________________________
(Street name and number)
______________________________________________________
__________________________ ____
____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
Principal office mailing address: ______________________________________________________
(if different from above)
(Street name and number or Post Office Box information)
______________________________________________________
__________________________ ____
____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
SHARE
Page 1 of 3
Rev. 6/16/2005
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