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Notice Of Sale Of Securities Form. This is a Delaware form and can be use in Blue Sky Department Of State.
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Tags: Notice Of Sale Of Securities, D-1, Delaware Department Of State, Blue Sky
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
SECURITIES COMMISSIONER
STATE OF DELAWARE No.
:
Calendar
Plaintiff(s)
:
FORM D-1
-against-
JUDICIAL SUBPOENA
:
:
NOTICE OF SALE OF SECURITIES
:
PURSUANT TO THE DELAWARE
Defendant(s)
LIMITED OFFERING EXEMPTION
:
......................................................
This form or SEC Form D must be filed with the Securities Commissioner in connection with any
transaction for which an exemption from the registration provisions of the Delaware Securities Act is
THE PEOPLE OF THE STATE OF NEW YORK
claimed under ยง 7309(b)(9) and Rule 502 of the Rules and Regulations Pursuant to the Delaware
Securities Act.
TO
1.
Name of Issuer:
GREETINGS:
2.
Address ofWE COMMAND YOU,Issuer business and excuses being laidState, you and each of you attend before
Executive Office of that all (Number and Street, City, aside, Zip Code):
,
the Honorable
at the
Court
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
________________________________________
3.
Telephone Number of Executive Office (including Area Code):
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.
4.
Address of Principal Business Operations (Number and Street, City, State, Zip Code) (if different
than Executive Office):
Witness, Honorable
, one of the Justices of the
Court in
County,
day of
, 20
5.
Telephone Number of Principal Business Operations (includingmust signCode): type name below)
(Attorney Area above and
6.
Give a brief description of the type of business in which the Issuer is engaged:
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
7.
:
State the dollar amount raised or sought to be raised by the offering: No.
Calendar
:
Plaintiff(s)
-against-
8.
Index No.
JUDICIAL SUBPOENA
:
State the dollar amount raised or sought to be raised by the offering in Delaware, if different than
:
item 7 above:
:
Defendant(s)
:
......................................................
9.
Provide the names and home and business addresses of all officers, directors, general or managing
partners. List all persons who own of record, or beneficially own, 10 percent or more of the
outstanding sharesTHE STATE OF NEW YORK
THE PEOPLE OF of any class of equity security of the Issuer:
TO
NAME AND ADDRESS
POSITION
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
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
_______________________________________
Your failure to comply with this subpoena is punishable asis contempt of court and will make you liable to
(Attach sheet if additional space a required)
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.
10. State whether any of the persons named in Item No. 9 has ever been convicted of a felony, convicted
Witness, Honorable
, adjudicated bankrupt
of any misdemeanor involving any aspect of the securities business,one of the Justices of the or made
Court in
day of
, been a principal of any company which was
a general assignmentCounty, benefit of creditors or20
for the
reorganized in bankruptcy, or whether any of such persons or companies has been the subject of an
administrative, civil or criminal proceeding instituted by a state or federal securities agency. If the
answer is "yes" explain fully:
(Attorney must sign above and type name below)
Attorney(s) for
____________________________________
Office and P.O. Address
_____________________________________________
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
2
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
11. State the name, home and business address, occupations, and Calendar No.
dollar amount paid by each
purchaser who is a Delaware resident.
:
JUDICIAL SUBPOENA
Plaintiff(s)
NAME
HOME AND BUSINESS
-againstADDRESS
OCCUPATION
:
DOLLAR AMOUNT
:
:
____________________________________________
Defendant(s)
:
......................................................
______________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
_____________________________________________
TO
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
12. If any Honorable utilized an Offeree Representative (or Purchaser Representative) state the name of ,
the purchase
at the
Court
theCounty of
Representative, his or her business address and the offeree or purchaser represented.
located at
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and
OFFEREE OR PURCHASER give evidence as a witness in this action on the part of the
BUSINESS
REPRESENTATIVE
ADDRESS
PURCHASER
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,
, one of the Justices of the
day of
, 20
(Attorney must sign above and type name below)
Attorney(s) for
13. Please provide on a separate sheet the information required in Section C of SEC Form D regarding
Offering Price, Number of Investors, Expenses and Use of Proceeds.
Office and P.O. Address
3
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
By signing this Form D-1, the issuer represents and affirms that it has compiled
with all of the conditions of the exemption which is :being claimed and that the
JUDICIAL SUBPOENA
Plaintiff(s)
information provided herein is true and correct.
-against-
:
:
Signed: ____________________________________ Date: _____________
:
Name and Title (Please print or type)
Defendant(s)
:
......................................................
State of Delaware
Department PEOPLE OF THE STATE OF NEW YORK
THE of Justice
Division of Securities
820 N. French Street
TO
Wilmington, DE 19801
Revised: January 5, 2000
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
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
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,
, one of the Justices of the
day of
, 20
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
4
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