STATE OF MISSISSIPPI Office of Secretary of State Securities Division Post Office Box 136 Jackson, Mississippi 39205 (601) 359-6369 NOTICE OF SALE OF SECURITIES PURSUANT TO RULE 705, SECTION 7571-203(13), MISSISSIPPI CODE OF 1972, AS AMENDED, EXEMPTION FROM REGISTRATION FOR CERTAIN OFFERINGS BY DOMESTIC ISSUERS GENERAL INSTRUCTIONS WHO MAY FILE - Any issuer organized under the laws of the State of Mississippi and making an offering of securities in reliance upon the exemption provided in Rule 705, Section 75-71-203(13), Mississippi Code 1972, as amended. WHEN TO FILE - A notice must be filed before the first sale of securities in the offering. A notice must be filed with the Mississippi Securities Division at the address below. WHERE TO FILE - Office of Secretary of State, Securities Division, 202 North Congress Street, Suite 601, Post Office Box 136, Jackson, Mississippi 39205. COPIES REQUIRED - One (1) copy, manually signed, of this notice must be filed with the Securities Division. FILING FEE - A filing fee of three hundred dollars ($300) must accompany the notice. COMPLETION OF FORM - If additional space is required to complete a response, a blank sheet should be used with the response numbered to correspond to the question on the form. ADDITIONAL INFORMATION - The Secretary of State is authorized to request additional information concerning the offering where appropriate. THIS NOTICE FILING IN NO WAY RELIEVES THE ISSUER OF ITS OBLIGATION TO PROVIDE THE INVESTOR FULL, MEANINGFUL DISCLOSURE AS REQUIRED UNDER THE MISSISSIPPI SECURITIES ACT AND THE RULES PROMULGATED THEREUNDER. 1 American LegalNet, Inc. www.USCourtForms.com A. GENERAL INFORMATION 1) NAME OF OFFERING 2) NAME OF ISSUER 3) ADDRESS OF PRINCIPAL OFFICE OF ISSUER (Number and Street, City, State, Zip Code) AND TELEPHONE NUMBER 4) NAME, ADDRESS AND TELEPHONE NUMBER OF CORRESPONDENT TO WHOM NOTICES MAY BE SENT 5) TYPE OF BUSINESS ORGANIZATION AND DATE ORGANIZED Corporation Limited Partnership Limited Liability Company Other (Please specify ) Date Organized: 6) ,19 DESCRIPTION OF BUSINESS FOR WHICH THE SECURITIES ARE ISSUED. 2 American LegalNet, Inc. www.USCourtForms.com B. BASIC IDENTIFICATION DATA 7) (a) ENTER THE INFORMATION REQUESTED FOR THE FOLLOWING: Each promoter of the issuer, if the issuer has been organized within the past five years; Each beneficial owner having the power to vote or dispose, or direct the vote or disposition of, 10% or more of a class of equity securities of the issuer; Each executive officer and director of corporate issuers and of corporate general and managing partners of partnership issuer; and Each general and managing partner of partnership issuers. Check Box (s) that Apply: Promoter Beneficial Owner General and/or Managing Partner Executive Director Director Full Name (Last name first, if individual) Business or Residence Address (Number and Street, City, State, Zip Code) (b) Check Box (s) that Apply: Promoter Beneficial Owner Executive Director Director General and/or Managing Partner Full Name (Last name first, if individual) Business or Residence Address (Number and Street, City, State, Zip Code) (c) Check Box (s) that Apply: Promoter Beneficial Owner Executive Director Director General and/or Managing Partner Full Name (Last name first, if individual) Business or Residence Address (Number and Street, City, State, Zip Code) 3 American LegalNet, Inc. www.USCourtForms.com (d) Check Box (s) that Apply: Executive Director Promoter Beneficial Owner Director General and/or Managing Partner Full Name (Last name first, if individual) Business or Residence Address (Number and Street, City, State, Zip Code) C. INFORMATION ABOUT OFFERING 8) DESCRIBE THE SECURITIES TO BE OFFERED. 9) WHAT IS THE MINIMUM INVESTMENT THAT WILL BE ACCEPTED FROM ANY INDIVIDUAL? 10) ENTER INFORMATION CONCERNING THE PAYMENT OF ANY COMMISSION OR SIMILAR REMUNERATION FOR THE SOLICITATION OF PURCHASERS IN CONNECTION WITH SALES OF SECURITIES IN THE OFFERING (NOTE: COMMISSIONS FOR RULE 705 OFFERINGS ARE NOT PERMITTED UNLESS APPROVED BY THE SECRETARY OF STATE). a) State commission per unit in dollar amount and as a percentage of unit purchase price: b) State commission for total offering in dollar amount and as a percentage of total offering proceeds: 4 . American LegalNet, Inc. www.USCourtForms.com c) List name and address of person(s) to whom commissions or other remuneration for sales will be paid: 11) D. DID THE ISSUER SELL ANY SECURITIES IN MISSISSIPPI DURING THE TWELVE (12) MONTHS PRECEDING THE DATE OF FILING? IF SO, DESCRIBE THE SECURITIES AND INDICATE THE NUMBER OF PURCHASERS AND THE DOLLAR AMOUNT SOLD TO EACH. OFFERING PRICE, NUMBER OF INVESTORS, EXPENSES AND USE OF PROCEEDS 12) ENTER THE AGGREGATE OFFERING PRICE OF SECURITIES INCLUDED IN THIS OFFERING TYPE OF SECURITY AGGREGATE OFFERING PRICE $ $ Debt Equity Common Convertible securities (including warrants) Partnership interests Other (specify Preferred $ $ $ ) $ Total 5 American LegalNet, Inc. www.USCourtForms.com 13) FURNISH A STATEMENT OF ALL EXPENSES IN CONNECTION WITH THE ISSUANCE AND DISTRIBUTION OF THE SECURITIES IN THIS OFFERING. IF THE AMOUNT OF AN EXPENDITURE IS NOT KNOWN, FURNISH AND ESTIMATE AND CHECK THE BOX TO THE LEFT OF THE ESTIMATE. Printing cost Legal fees Accounting fees Engineering fees Sales commissions Other expenses (specify $ $ $ $ $ $ ) Total 14) $ ENTER THE DIFFERENCE THE AGGREGATE OFFERING PRICE IN RESPONSE TO QUESTION 12 AND TOTAL EXPENSES FURNISHED IN RESPONSE TO QUESTION 13. THIS DIFFERENCE IS THE ''ADJUSTED GROSS PROCEEDS TO THE ISSUER.'' $ 15) INDICATE BELOW THE AMOUNT OF THE ADJUSTED GROSS PROCEEDS TO THE ISSUER USED OR PROPOSED TO BE USED FOR EACH OF THE PURPOSES SHOWN. IF THE AMOUNT FOR ANY PURPOSE IS NOT KNOWN, FURNISH AN ESTIMATE AND CHECK THE BOX TO THE LEFT OF THE ESTIMATE. THE TOTAL OF THE PAYMENTS LISTED MUST EQUAL THE ADJUSTED GROSS PROCEEDS TO THE ISSUER SET FORTH IN RESPONSE TO QUESTION 14. PAYMENT TO OTHERS PAYMENT TO OFFICERS DIRECTORS & AFFILIATES Salaries and fees $ $ Purchase of Real Estate $ $ Purchase, rental or leasing and installation of machinery and equipment $ $ Acquisition of other Businesses $ $ (including the value of securities involved in this offering that may be used in exchange for the assets of securities of another issuer pursuant to merger) 6 American LegalNet, Inc. www.USCourtForms.com Repayment of indebtedness Working capital Other (specify $ $ $ COLUMN TOTALS $ $ $ $ ) $ TOTAL PAYMENTS LISTED $ 16) IDENTIFY ANY OTHER STATE IN WHICH IT IS PROPOSED TO OFFER THE SECURITIES OR IN WHICH THE SECURITIES ARE ELIGIBLE. 17) IDENTIFY ANY STATE: (1) WHICH HAS REFUSED, BY ORDER OR OTHERWISE, TO AUTHORIZE THE SALE OF THE SECURITIES, OR (2) HAS REVOKED, ENJOINED OR SUSPENDED THE RIGHT OF ANYONE LISTED IN RESPONSE TO QUESTIONS 7 OR 10(c) TO SELL SECURITIES IN THAT STATE, OR (3) IN WHICH AN APPLICATION HAS BEEN WITHDRAWN. 18) WHAT, IF ANY, SUITABILITY STANDARDS WILL BE USED IN DETERMINING AN INVESTOR'S QUALIFICATIONS FOR THE PURCHASE OF THE SECURITIES? 19) DESCRIBE ANY CONFLICTS OF INTEREST ON THE PART OF ANY PROMOTER, DIRECTOR, SALES PERSON OR AFFILIATED PERSON. 20) DESCRIBE SIGNIFICANT RISK FACTORS. 7 American LegalNet, Inc. www.USCourtForms.com The Issuer has read this notification and knows the contents to be true and correct and has duly caused this notice to be signed on its behalf by the undersigned authorized person. ISSUER SIGNATURE NAME TITLE day of Subscribed and sworn before me, this DATE ,19 . State of Signature of Notary Public County of 8 American LegalNet, Inc. www.USCourtForms.com