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Notice Claiming Maryland Limited Offering Exemption Form. This is a Maryland form and can be use in Blue Sky Secretary Of State.
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Tags: Notice Claiming Maryland Limited Offering Exemption, MLOE-1, Maryland Secretary Of State, Blue Sky
FORM MLOE-1
State of Maryland
Office of the Attorney General
Securities Division
NOTICE CLAIMING MARYLAND LIMITED OFFERING EXEMPTION (MLOE)
Under The Maryland Securities Act
Section 11-602(9) and Regulations 02.02.04.09-.13
If the aggregate dollar amount of the securities offered everywhere exceeds $150,000 in any
transaction under the Maryland Limited Offering Exemption (MLOE), the issuer shall deliver this
Notice to the Securities Commissioner by the end of business on the fifteenth day after the first sale
of securities in Maryland. This Notice shall be considered filed with the Division for purposes of
MLOE as of the date the Division receives the Notice, Form U-2 (Uniform Consent to Service of
Process), and filing fee of $400 paid by check. Make checks payable to "Office of the Attorney
General", and submit to “Maryland Division of Securities, 200 St. Paul Place, Baltimore, Maryland
21202-2020”. For copies of the statutes, regulations, and forms, contact the Maryland Division of
Securities at 410-576-7050.
Please attach additional sheets if additional space is required.
Applicable” if an item does not apply.
Indicate “Not
1.
Name of Issuer
Address of Issuer
______________________________________________ (
)
City, State, Zip Code
Telephone Number
_________________________________
e-mail
2.
______________________________________
website address
Other contact to whom communications regarding this Notice should be directed:
Name
Address
City, State, Zip Code
(
)
Telephone Number
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3.
Please describe, in summary form, the issuer's business:
4.
Issuer's type of business organization:
_____
_____
_____
_____
Corporation
_____ Real estate investment trust
Partnership
_____ Joint venture
Limited liability company
Other* (specify) ____________________________________________________
*If "Other," please attach a copy of the Securities Commissioner's order extending the
availability of MLOE to the issuer, or a request for such an order.
5.
Issuer’s year of formation: ___________________________________________________
6.
Issuer’s jurisdiction of formation: _____________________________________________
7.
The issuer’s exemption from federal registration for this offering:
_____
_____
_____
_____
Section 4(2)
_____ Section 3(a)(11)
Rule 504
_____ Rule 701
Rule 147
Other* (specify) ____________________________________________________
*If “Other”, please attach a copy of the Securities Commissioner's order extending the
availability of MLOE to the issuer, or a request for such an order.
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8.
The other states in which the issuer proposes to offer or sell securities in connection with
this offering:
9.
The type of securities being offered are:
_____
_____
_____
_____
_____
_____
_____
_____
_____
Common stock
_____ Shares of beneficial interest
Notes
_____ Warrants, options or rights to purchase
Bonds
or subscribe for any of the above
Debentures
_____ Preferred Stock
Evidence of indebtedness
_____ Convertible Securities
Voting trust certificates
_____ LLC memberships
Limited Partnership interests
_____ General Partnership Interests
Other securities convertible into any of the above
Other* (specify) ____________________________________________________
________________________________________________________________________
*If "Other," please attach a copy of the Securities Commissioner's order extending the
availability of MLOE to the issuer, or a request for such an order.
10.
Within the six months before this offering began, did the issuer offer or sell any securities
of the same or similar class as those being sold in Maryland under this offering?
Yes
No
If "Yes," and the issuer is located in Maryland, or the securities were sold in Maryland:
(a)
(b)
(c)
Describe the security(ies) _____________________________________________
Provide the date previous offering began and date it terminated _______________
What exemption did the issuer rely upon? ________________________________
If “Yes,” the issuer may refer to COMAR 02.02.04.10.B(4), describing integration, and
consider addressing B(4) (a) through (e) on separate sheets.
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11.
(a)
(b)
Date this offering began:
Date of the first sale in Maryland (See Maryland Securities Act, Corporations and
Associations Article, §11-801, Annotated Code of Maryland):
12.
(a)
(b)
(c)
(d)
(e)
Aggregate price of all securities offered everywhere: $
Aggregate price of all securities offered in Maryland: $
Number of units offered:
Price per unit offered: $
Warrants __________________________________________________________
13.
On separate sheets, please state the name, home address and position of each officer,
director, managing member, general partner, or trustee of the issuer.
If the general partner or trustee is a corporation or other entity, provide the requested
information for each officer, director, managing member, or general partner of that entity.
14.
On separate sheets, state the name and home address of each beneficial owner of 10
percent or more of the outstanding shares of any class of equity ownership of the issuer.
15.
On separate sheets, state the name, CRD number, address and telephone number of each
broker/dealer authorized by the issuer to sell securities of the issuer in this offering.
16.
On separate sheets, state the name, CRD number, address and telephone number of each
individual or finder authorized by the issuer to sell securities of the issuer in this offering.
Is (are) the person(s) affiliated with the issuer? Yes
No
If "yes", in what capacity:
Type and value of any remuneration to the person(s) for sale of securities (if "none",
please so state):
Is this person a broker-dealer or a broker-dealer agent?
Yes
No
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17.
Indicate whether :
(a) the issuer,
(b) any of its directors, officers, general partners, managing members, trustees, or any
other person performing similar functions,
(c) beneficial owners of ten percent or more of any class of its equity securities,
(d) any of the issuer's promoters currently connected with it in any capacity, or
(e) any person (other than a broker-dealer currently registered under the Maryland
Securities Act, §11-405, Annotated Code of Maryland) that has been or will be paid or
given, directly or indirectly, a commission or similar remuneration for the solicitation of a
prospective purchaser or in connection with sales of securities under MLOE:
(i)
Within five years before the first sale of securities in this offering, has
filed a registration statement or an application for exemption from registration that
is currently subject to a stop order under a state's securities laws.
Yes
No
additional sheets.
If "Yes", please provide complete details using
(ii)
Within five years before the first sale of securities in this offering, has
been convicted of or has pleaded nolo contendere to a felony or misdemeanor in
connection with the offer, purchase, or sale of a security or in connection with the
making of a false filing with the Securities and Exchange Commission or with a
state securities administrator, or a felony involving fraud or deceit, including, but
not limited to, forgery, embezzlement, obtaining money under false pretenses,
larceny, conspiracy to defraud, or theft.
Yes
No
additional sheets.
If "Yes", please provide complete details using
(iii) Is subject to an order, judgment, or decree of a court of competent
jurisdiction temporarily or preliminarily restraining or enjoining, or is subject to
an order, judgment, or decree of a court of competent jurisdiction entered within
five years before the first sale of securities in this offering and permanently
restraining or enjoining, that person from engaging in or continuing any conduct
or practice in connection with the offer, purchase, or sale of a security or in
connection with the making of a false filing with the Securities and Exchange
Commission or a state securities administrator.
Yes
No
additional sheets.
If "Yes", please provide complete details using
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(iv)
Is subject to a United States Postal Service false representation or cease
and desist order entered under 39 U.S.C. §3005 within five years before the first
sale of securities in this offering or is subject to a temporary restraining order or
preliminary injunction entered under 39 U.S.C. §3007 or 18 U.S.C. §1345 with
respect to conduct alleged to have violated 39 U.S.C. §3005.
Yes
No
additional sheets.
If "Yes", please provide complete details using
(v) Is subject to a state administrative order entered by a state securities
administrator in which fraud or deceit was found, if the final order was entered
within five years before the first sale of securities in this offering.
Yes
No
additional sheets.
18.
Is the issuer, any of its predecessors, or any of its affiliates subject to an order issued by
the Securities Commissioner or subject to an order, judgment, or decree of a court of
competent jurisdiction temporarily, preliminarily, or permanently restraining or enjoining
the person for failure to file a Form MD-1 or Form MLOE-1.
Yes
additional sheets.
19.
If "Yes", please provide complete details using
No
If "Yes", please provide complete details using
If any of the questions in paragraphs 17 or 18 were answered "Yes", please provide a
copy of the order, judgment, decree, injunction or other action.
I do solemnly declare and affirm under penalties of perjury that to the best of my
knowledge, information and belief, the contents of the foregoing document are true and correct.
Signature:
Printed Name:
Title:
Date of Notice:
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"It is unlawful for any person to make ... in any document filed with the Commissioner ...
any statement which is, at the time and in the light of the circumstances under which it is
made, false or misleading in any material respect."
Section 11-303, Corporations & Associations Article, Annotated Code of Maryland
November 5, 2004
r:\forms\ secur\ mloe-1-2004.frm
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