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Undertaking - Quarterly Reports Form. This is a Colorado form and can be use in Blue Sky Secretary Of State.
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
Form C
Plaintiff(s)
-against-
Calendar No.
:
JUDICIAL SUBPOENA
:
:
STATE OF COLORADO
DEPARTMENT OF REGULATORY AGENCIES – DIVISION OF SECURITIES
:
Defendant(s)
:
. .UNDERTAKING. – .Quarterly. Reports . . . . . . . . . . . . . . . .
............... . ......... ........
NOTICE:
The OF NEW YORK
THE PEOPLE OF THE STATEfollowing should be read carefully before execution. The
TO
Registrant should keep a copy for future reference. Failure to comply with
this Undertaking may result in the issuance of a stop order.
UNDERTAKING
By: _________________________________(the “Registrant”)
GREETINGS:
WE COMMAND YOU, that all the registration being securities and the you attend
The Registrant has applied for business and excusesof its laid aside, youwith each ofColorado before
,
the Honorable Securities in order to make a at the offering of its securities. In connection
Court
Division of
public
located at
County of
with that application, the Registrant agrees to the following undertaking.
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Within 10 days after the end of each three-month period following the effective date of
the registration statement, the Registrant shall file with the Division of Securities a
quarterly report. Such quarterly report shall include the following information:
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalfChanges in Control of themaximum penalty of $50 and all damages sustained as a
this subpoena was issued for a Registrant.
Item A.
result of your failure to comply.
i.
If, to the knowledge of management, a change in control of the
Witness, Honorable
, one of the Justices of the
Registrant has occurred, state the name and address of the
Court in
County,
day of
, 20
person(s) who acquired such control; the amount and the source of
the consideration used by such person(s); the basis of the control;
the date and a description of the transaction(s) which resulted in
the change in control; the percentage of votingand type name below)the
(Attorney must sign above securities of
Registrant now beneficially owned directly or indirectly by the
person(s) who acquired control; and the identity of the person(s)
from who control was assumed.Attorney(s) for
Instructions:
1.
State the terms of any loans or pledges obtained by the new
control group for the purpose of acquiring control, and the
Office and P.O. Address
names of the lenders or pledgees.
2.
Any arrangements or understandings among members of
both the former and newTelephonegroups and their associates
control No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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:
:
Index No.
Calendar No.
with respect to the election: of directors or other matters shall
JUDICIAL SUBPOENA
Plaintiff(s)
be described.
-against-
ii.
:
:
Describe any arrangements, known to the Registrant, including any
pledge by any person of securities of the Registrant or any of its
:
parents, the operation of which may at a subsequent date result in a
change in control Defendant(s)
of the registrant. :
......................................................
Item B.
Acquisition or Disposition of Assets.
If the Registrant or any of
THE PEOPLE OF THE STATE OF NEW YORKits majority-owned subsidiaries has acquired or
TO
disposed of a significant amount of assets, otherwise than in the ordinary
course of business, furnish the following information:
i.
The date and manner of the acquisition or disposition and a brief
description of the assets involved, the nature and amount of
GREETINGS:
consideration given or received therefor, the principal followed in
determining the amount of such consideration, the identity of the
WE COMMAND YOU, that from whom the assets were aside, you and each of you they before
person(s) all business and excuses being laid acquired or to whom attend
,
the Honorable
at the
Court
were sold and the nature of any material relationship between such
located at
County of
person(s) and the Registrant or any of its affiliates, and director or
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
officer of the Registrant, or any associate of any such director or
or adjourned date, to testify and give evidence as a witness in this action on the part of the
officer. If the transaction being reported is an acquisition, identify
the source(s) of the funds used.
Your failure to comply with this subpoena is punishablethea Registrant court its subsidiaries liable to
ii.
If any assets so acquired by as contempt of or and will make you
the party on whose behalfconstituted plant, equipment or other physical property, state sustained as a
this subpoena was issued for a maximum penalty of $50 and all damages the
result of your failure to comply. of the business in which the assets were used by the
nature
person(s) from whom acquired and whether the Registrant intends
Witness, Honorablecontinue such use or intends to devote of theassets of the
, one the Justices to other
to
Court in
County,
day of
, other purposes.
purposes, indicating such 20
Instructions:
1.
The term “acquisition” includesmust sign above and type name below)
(Attorney every purchase, acquisition
by lease, exchange, merger, consolidation, succession or
other acquisition; provided that such term does not include
the construction or development for property by or for the
Attorney(s) of
Registrant or its subsidiaries or the acquisition of materials
for such purpose. The term “disposition” includes every
sale, disposition by lease, exchange, merger, consolidation,
mortgage, or hypothecation of assets, assignment, whether
Office and P.O. Address
for the benefit of creditors or otherwise, abandonment,
destruction, or other disposition.
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
2
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:
Index No.
Calendar No.
The information called for :by this item is to SUBPOENA to
JUDICIAL be given as
Plaintiff(s)
each transaction or series of related transactions of the size
-againstindicated. The acquisition: or disposition of securities shall
be deemed the indirect acquisition or disposition of the
:
assets represented by such securities if it results in the
acquisition or disposition of control of such assets.
:
2.
3.
An acquisition or disposition shall be deemed to involve a
Defendant(s)
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . .significant. amount. of .assets if the Registrant’s and its other
......... ....... .. .....
subsidiaries’ equity in the net book value of such assets or
the amount paid or received therefor upon such acquisition
or disposition
THE PEOPLE OF THE STATE OF NEW YORK exceeded 10 percent of the total assets of the
Registrant and its consolidated subsidiaries.
TO
4.
Where assets are acquired or disposed of through the
acquisition or disposition of control of a person, the person
from whom such control was acquired or to whom it was
GREETINGS:
disposed of shall be deemed the person from whom the
assets were acquired or to who they were disposed of, for
WE COMMAND YOU, the purposes of this item. Whereaside, you and each of acquired before
that all business and excuses being laid such control was you attend
,
the Honorable
at the
Court
from or disposed of to not more than five persons, their
located at
County of
names shall be given; otherwise it will suffice to identify in an
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
appropriate manner the class of such persons.
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Item C.
Bankruptcy or Receivership.
Your failure to comply with this fiscal agent or similar officer has been and will make you liable to
i.
If a receiver, subpoena is punishable as a contempt of court appointed for a
the party on whose behalfRegistrant orwas issued forin maximum penalty of $50the Bankruptcysustained as a
this subpoena its parent, a a proceeding under and all damages Act
result of your failure to comply. any other proceeding under State or Federal law in which a
or in
court or governmental agency has assumed jurisdiction over
Witness, Honorable
, of the Registrant or
substantially all of the assets or business one of the Justices of the its
Court in
County,
day such jurisdiction has been assumed by leaving the
, 20
parent, or ifof
existing directors and officers in possession but subject to the
supervision and orders of a court or governmental body, identify the
proceeding, the court or governmental body, the datename below)
(Attorney must sign above and type jurisdiction
was assumed, the identity of the receiver, fiscal agent or similar
officer and the date of his appointment.
ii.
Attorney(s) for
If an order confirming a plan of reorganization, arrangement or
liquidation has been entered by a court or governmental authority
having supervision or jurisdiction over substantially all of the assets
or business of the Registrant or its parent, furnish the following:
Office and P.O. Address
a.
the identity of the court or governmental authority;
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
3
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......... ..
:
:
b.
Calendar No.
:
the date the order confirming the plan was SUBPOENA
JUDICIAL entered by the
Plaintiff(s)
court or governmental authority;
-against-
c.
Index No.
:
a fair summarization of the material features of the plan and,
:
pursuant to Item 6 of this form relating to exhibits, a copy of
the plan as confirmed;
:
d.
the number of shares or other units of the Registrant or its
Defendant(s)
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . .parent . issued. .and. .outstanding, the number reserved for
...... ...... ... ......
future issuance in respect of claims and interests filed and
allowed under the plan, and the aggregate total of such
numbers; and
THE PEOPLE OF THE STATE OF NEW YORK
e.
TO
GREETINGS:
information as to the assets and liabilities of the Registrant or
its parent as of the date the order confirming the plan was
entered, or a date as close thereto as practicable. Such
information may be presented in the form in which it was
furnished to the court or governmental authority.
WE COMMAND YOU, that all business and excuses Directors.
Item D.
Resignations of Registrant’s being laid aside, you and each of you attend before
,
the Honorable
at the
Court
located at
County of
i.
If a director has resigned or declined to stand for re-election to the
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
board of directors since the date of the last annual meeting of
or adjourned date, to testify and give evidence as a witness in this action on the part of the
shareholders because of a disagreement with the Registrant on any
matter relating to the Registrant's operations, policies or practices,
and if the director has furnished the Registrant with a letter
Your failure to comply with this subpoena is punishable as arequesting court and will make be liable to
describing such disagreement and contempt of that the matter you
the party on whose behalf this subpoena was issued forshall state the date of suchall damages sustained as a
disclosed, the Registrant a maximum penalty of $50 and resignation or
result of your failure to comply.
declination to stand for re-election and summarize the director's
description of the disagreement.
Witness, Honorable
, one of the Justices of the
Court in
day of
, 20
ii. County,
If the Registrant believes that the description provided by the
director is incorrect or incomplete, it may include a brief statement
presenting its views of the disagreement.
(Attorney must sign above and type name below)
iii.
The Registrant shall file a copy of the director’s letter as an exhibit
with the quarterly report required to be filed.
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
4
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:
Item E.
Financial Statements.
Plaintiff(s)
i. Rule-against51-7.4
Calendar No.
:
JUDICIAL SUBPOENA
:
Form and Content of Financial Statements
:
A. The annual financial statements, or any other financial statements
required to be filed with the Commissioner, except as noted in B.
:
below, shall be audited by a Certified Public Accountant ("CPA")
and contain: Defendant(s)
:
......................................................
An Unqualified Auditor's Report,
Balance Sheet,
Statement
THE PEOPLE OF THE STATE OF NEW YORKof Operations,
Statement of Changes in Shareholders' Equity
Statement of Cash Flows, and
TO
All notes and disclosures as required by generally accepted
accounting principles ("GAAP")
GREETINGS:
Comparative financial statements shall be prepared for all entities
that have been in operation for more than 12 months.
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
B. The Interim financial statements required to be filed with the
located at
County of
Commissioner shall be reviewed by a CPA and contain:
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
A CPA's Unqualified Accountant's Review Report,
Balance Sheet,
Statement of Operations,
Your failure to comply withStatement of is punishable as a contempt of Equity will make you liable to
this subpoena changes in Shareholders' court and
the party on whose behalf this subpoena was issuedCashmaximum penalty of $50 and all damages sustained as a
Statement of for a Flows, and
result of your failure to comply.
All notes and disclosures as required by GAAP
Witness, Honorable
, one
unless waived by order of the Commissioner. of the Justices of the
Court in
County,
day of
, 20
Comparative financial statements shall be prepared for all entities
that have been in operation for more than 12 months.
(Attorney must sign above and type name below)
C. Any and all other presentations of financial data including, but not
limited to, projections and supplementary data shall be reviewed by
a CPA and be covered by an Unqualified Accountant's Review
Attorney(s) for
Report issued by a CPA.
ii.
Item F.
For any business acquisition required to be described in answer to
Office and P.O. Address
Item B above, provide the same information as required by section
E(i) above.
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
List of purchasers.
5
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Plaintiff(s)
Calendar No.
:
JUDICIAL SUBPOENA
i.
List the amount of securities purchased and the amount of funds
-against:
invested by each purchaser in this offering.
ii.
:
Include the date(s) of purchase(s).
iii.
Include the legal address of each purchaser.
:
Defendant(s)
:
......................................................
Item G.
Other Events.
The OF NEW YORK
THE PEOPLE OF THE STATERegistrant shall report under this Item G any material events
with respect to which information is not otherwise called for by this
quarterly report.
TO
DATED this _______ day of _______________________, 20____.
GREETINGS:
WE COMMAND YOU, that all business________________________________ attend before
and excuses being laid aside, you and each of you
,
the Honorable
at the
Court
(Name of Registrant)
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
________________________________
(Name and position of duly authorized
signing officer)
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
___________________________________
Witness, Honorable
Court in
County,
(Director)
, one of the Justices of the
___________________________________
day of
, 20
(Director)
___________________________________
(Attorney must sign above and type name below)
(Director)
(Rev. 5/2000)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
6
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