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Notice Of Exempt Securities Transactions Under AS 45.55.900(b)(19) Form. This is a Alaska form and can be use in Blue Sky Secretary Of State.
Tags: Notice Of Exempt Securities Transactions Under AS 45.55.900(b)(19), 08-111, Alaska Secretary Of State, Blue Sky
Department of Commerce, Community & Economic Development Division of Banking & Securities, Securities Section P.O. Box 110807 Juneau, AK 99811 Telephone: (907) 465-2521 Email: firstname.lastname@example.org Notice of Exempt Securities Transactions (To be filed along with the fee required by 3 AAC 08.920 (a)(11)) Under AS 45.55.900(b)(19) STATUTORY REFERENCE AS 45.55.900(b) The following transactions are exempted from AS 45.55.070 and 45.55.075: (19) an offer to repay, under AS 45.55.930, the buyer of a security if the offeror first files with the administrator a notice specifying the terms of the offer at least 10 days before the offer is made. REMEMBER TO FILE Form 08-111A WHEN THE RESCISSION OFFER HAS BEEN COMPLETED. 1. Name, Address and Telephone number of person requesting the use of this exemption: Phone Full Name of contact person Address Fax The person signing this form must show name & address above. If for some reasons that person is not available to sign, please request a waiver in writing and give reason. 2. Name, Address, and Telephone number of Issuer: Name of Issuer Address Phone 3. Please provide a brief description of the security which was sold without registration or exemption from registration (describe security, price, and interest, if any): 4. (May not be sooner than 10 days after the filing date of this exemption notice or as determined by the administrator). 5. Describe any special considerations you ask the administrator to consider, including any requests for waiver of any limitations of the exemption. Waiver requests must include full disclosure to the administrator of the facts and relevant material factors relating to the request. Date rescission offer will commence: American LegalNet, Inc. www.FormsWorkFlow.com 08-111 Rev. 01/16 Page 1 of 2 6. Describe where the money to repay purchasers will come from and whether it will be sufficient to meet the rescission and leave the entity able to carry on its business: Additional information (Please refer to paragraph number being further explained): ATTACH A COPY OF THE RESCISSION OFFER( AS 45.55.900(b)(19) AND ALL DISCLOSURES PROVIDED UNDER 3 AAC 08.915. INCLUDE A LIST OF THE NAME, ADDRESSES OF THE PERSONS BEING OFFERED RESCISSION AND DOLLAR AMOUNTS OF THE SECURITIES INVOLVED. BE SURE TO FILE FORM 08-111A WHEN THE OFFER OF RESCISSION HAS BEEN COMPLETED By filing this notice, I affirm that all statutory requirements of AS 45.55.900(b)(19) and 3 AAC 08.915 have been met to date and will continue to be met during the offering period. Signature of attorney or principal (please describe which) E-mail address : Title Date American LegalNet, Inc. www.FormsWorkFlow.com 08-111 Rev. 01/16 Page 2 of 2