Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Notice Of Exchange Transaction Form. This is a California form and can be use in Blue Sky Secretary Of State.
Loading PDF...
Tags: Notice Of Exchange Transaction, 25103(h), California Secretary Of State, Blue Sky
(Department of Corporations
Use Only)
Fee Paid $ ___________________
Receipt No. __________________
DEPARTMENT OF CORPORATIONS
FILE No., if any:
_____________________________ _
(Insert File Numbers(s) of Previous
Filings Before the Department, If Any)
FEE: $600
(See Corporations Code Section 25608(z))
COMMISSIONER OF CORPORATIONS
STATE OF CALIFORNIA
NOTICE OF EXCHANGE TRANSACTION
PURSUANT TO CORPORATIONS CODE SECTION 25103(h)
1.
Name of Acquiring Entity: __________________________________
2.
(a)
Address of Acquiring Entity:
_______________________________________________________
Street
City
State
ZIP
(b)
Mailing Address:
_______________________________________________________
Street
City
State
ZIP
(c)
3.
Area Code and Telephone Number: _______________________
Acquiring Entity's state (or other jurisdiction) of
incorporation or organization: __________________________
4.
(a)
Name of Entity to be Acquired:
_______________________________________________________
(b)
State (or other jurisdiction) of incorporation or
organization of Entity to be Acquired: ________________
5.
The exchange of securities meets the requirements of (check one):
[ ] Section 25103(h)(1)(A) of the Code.
[ ] Section 25 103(h)(1)(B) of the Code, and the state of
incorporation or organization is _____________________, or
the form of organization is _______________________.
6.
Type of filing under the Securities Act of 1933, if
applicable: _______________________________________________
7.
Date of Notice: __________
(
) Check if Acquiring
Entity has a consent
to service of process
on file with the
Commissioner.
_________________________________
Acquiring Entity
_________________________________
Authorized Signature on
Behalf of Acquiring Entity
_________________________________
Print Name and Title of Signatory
25103(h) (Revised 5/97)
2001 © American LegalNet, Inc.
Name, Address and Phone Number of Contact Person:
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Instructions: Each Acquiring Entity (other than a
California corporation) filing a notice under Section
25103(h) must file a consent to service of process (Form
260.165), unless it already has a consent to service on file
with the Commissioner.
2001 © American LegalNet, Inc.
