Department Use Only __________ Fee paid: $ __________________ Receipt No. __________________ A. Department of Corporations File No. ______________________ (Insert file number(s) of prior filings with the Department, if any) STATE OF CALIFORNIA DEPARTMENT OF CORPORATIONS FRANCHISE INVESTMENT LAW NOTICE OF EXEMPTION UNDER SECTION 31101, 31104, 31108, OR 31109 CORPORATIONS CODE SEE INSTRUCTIONS B. Exemption for which this notice is filed (check one): ( ) Section 31101 ( ) Section 31104 ( ) Section 31108 ( ) Section 31109 C. Type of Filing (check one): ( ) Initial notice ( ) Consecutive subsequent notice ( ) Amendment D. Calendar year for which this notice is filed: ___________ 1. (a) (b) (c) $450 fee $150 fee No fee (d) (e) ****** Name of FILER: ___________________________________________________ Principal business address of FILER: ___________________________________ The above-named company is filing as a (check one): ( ) FRANCHISOR ( ) SUBFRANCHISOR If FILER is a SUBFRANCHISOR, the name and principal business address of the FRANCHISOR: ___________________________________________________ _________________________________________________________________ Name(s) under which FRANCHISOR does business: ______________________ _________________________________________________________________ 2. Name and address of agent in California authorized to receive service of process: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 3. Franchise to be offered: (a) Name of franchise or subfranchise: ____________________________________ Description of franchised business: ____________________________________ Type of franchise (check one): ( ) Franchise ( ) Subfranchise (b) Name of franchise or subfranchise: ____________________________________ Description of franchised business: ____________________________________ Type of franchise (check one): ( ) Franchise ( ) Subfranchise 310.101 (Rev. 1/06) American LegalNet, Inc. www.USCourtForms.com 4. Name, title, telephone number and business address of individual to be contacted by the Department regarding this notice: Name: ________________________________________________________________ Title: _________________________________________________________________ Business Address: ______________________________________________________ Telephone: ( ) _______________________________________________________ 5. Date of this notice: ______________________________ _________________________________ Name of Filer _____________________________ Authorized Signature _____________________________ Printed Name of Signatory 2 310.101 (Rev. 1/06) American LegalNet, Inc. www.USCourtForms.com (b) The following instructions apply to the form and information required by Subsection (a): INSTRUCTIONS FOR COMPLETING AND FILING NOTICE OF EXEMPTION (Sectional references are to the California Corporations Code) 1. General Instructions. (a) The notice required of persons claiming the exemption under Section 31101, 31104, 31108, or 31109 may be filed at any time after July 1 of the year preceding the calendar year for which the notice is required to be filed. For example, the notice for the calendar year 2006 may be filed at any time between July 1, 2005 and December 31, 2005. A notice may be filed in the same year the exemption is claimed. However, the effective date of the notice will be the date the completed notice is filed. For example, if a completed notice is filed March 21, 2006, it will be effective March 21, 2006 through December 31, 2006. The subsequent notice for 2007 should be filed prior to December 31, 2006 (by the end of the year in which the current notice is effective). A separate notice must be filed for each calendar year, together with the fee specified in Section 31500(f), prior to any offer or sale of a franchise in this state (other than a "material modification" [Section 31018(c)], for the exemption under Section 31101, 31104, 31108 or 31109). The notice for each claimed exemption must be filed only once for each calendar year, even if franchises are sold to one or more franchisees under the exemption claimed for that calendar year. (b) If the notice is filed by a subfranchisor (Section 31009), the notice is applicable only to offers and sales by the subfranchisor filing the notice. (c) No documents need be filed with the notice. (d) If the notice form cannot be obtained from the Department, it may be typed on a single sheet of 8 1/2 inch by 11 inch white bond paper, using one side only. If the space in the form is insufficient for one or more items, attach a single continuation sheet, designating the continued information by item number. (e) Amendments. An amendment should be filed only for material changes in the information contained in the notice, such as a change in the name under which the franchisor does business or an addition to Item 3 (e.g., new type of franchise). 2. Instructions for Completing Form. Heading: (A) Department file number. Insert the file number(s) assigned to the filing franchisor or subfranchisor in any prior registration filings with the Department under the Franchise Investment Law. (B) Exemption used. Check the box to indicate the exemption to be used by the Filer. (C) Type of filing. Check the box as appropriate to indicate whether the filing is an initial filing (including a non-consecutive subsequent notice), consecutive subsequent notice, or an amendment to a notice previously filed for the calendar year specified in the notice. 3 310.101 (Rev. 1/06) American LegalNet, Inc. www.USCourtForms.com (D) Calendar year. Indicate the calendar year for which the notice is filed. Item 1. The information provided in parts (a), (b) and (c) relate to the company filing the notice (i.e., the "filer") which may be the franchisor or a subfranchisor. If a subfranchisor files the notice, part (d) must be completed to give the name and business address of the franchisor. Part (e) must state the names associated with the franchisor's business. Item 2. If the notice is filed by a subfranchisor, the agent(s) for service of process of both the franchisor and subfranchisor must be furnished. Item 3. Specify the name or title given the franchise agreement. Briefly describe the franchised business (e.g. "restaurant," "retail sales of bicycles"). Check the box to specify whether the franchise is one to conduct the franchised business (Corp. Code Section 31010) or a subfranchise (Corp. Code Section 31008.5). Item 4. Give the name, title, business address and telephone number of the individual the Department may contact in connection with the notice. Item 5. The notice shall be signed on behalf of the filing franchisor or subfranchisor by a person authorized to do so. 3. Filing the Notice. The notice may be filed, and the fee may be paid, by mail or delivery to any office of the Department of Corporations. The completed notice is effective when received with the fee (Section 31101(d), 31108(f), or 31109(e)). 4 310.101 (Rev. 1/06) American LegalNet, Inc. www.USCourtForms.com