STATE OF CALIFORNIA ­DEPARTMENT OF BUSINESS OVERSIGHT SECOND NOTICE OF TRANSACTION PURSUANT TO CORPORATIONS CODE SECTION 25102 (n) DBO ­260.102.16 (Rev. 09-15) (Department of Business Oversight Use Only) Fee paid $__________________________ DEPARTMENT OF BUSINESS OVERSIGHT NOTICE-NO: _________________________________________ Insert Notice-No(s) of Previous Filings Before the Department, if any Check One: Transaction under Section 25102(n) Transaction under Rule 260.103 with Notice pursuant to Section 25102(n) 1. 2. Name of Issuer: ______________________________________________________________________ Address of Issuer: ____________________________________________________________________ Street City State Zip Mailing Address:_____________________________________________________________________ Street City State Zip Area Code and Telephone Number: ______________________________________________________ Date of Filing of First Notice: __________________________________________________________ Date of close or abandonment of the offering: ______________________________________________ Title of class of classes of securities to be sold in the transaction: ______________________________ Type of filing under Securities Act of 1933, if applicable: ____________________________________ Date of Second Notice: ____________ _________________________________ Issuer ____________________________________ Authorized Signature on behalf of Issuer ________________________________________ 3. 4. 5. 6. 7. 8. Check if issuer already has a consent to service of process on file with the Commissioner. Print name and title of signatory Name, Address, and Phone number of contact person: _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ Instruction: Each issuer (other than a California Corporation) filing a notice under Section 25102(n) must also file a Consent to Service of Process (Form 260.165), unless it already has a valid consent to service on file with the Commissioner. American LegalNet, Inc. www.FormsWorkFlow.com