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Statement Of Claim For Exemption Of Securities Of New Generation Processing Entity Form. This is a Missouri form and can be use in Blue Sky Secretary Of State.
Tags: Statement Of Claim For Exemption Of Securities Of New Generation Processing Entity, SE-1, Missouri Secretary Of State, Blue Sky
John R. Ashcroft Secretary of State State of Missouri Securities Division · 600 W. Main, Rm. 229 · PO Box 1276 Jefferson City, MO 65102 Statement of Claim for the Exemption of Securities of a New Generation Processing Entity 1. Name and principal address of the issuer: 2. Date of organization of the issuer and the form of organization, including the Missouri statute under which the issuer was created: 3. Name, address and telephone number of the correspondent to whom notices and communications regarding the notice filing may be sent: ________________________________________________________________________________________________________ 4. Provide a statement that explains how the issuer and its business meets the definition of a "new generation processing entity" under Missouri Regulation 15 CSR 30-54.190(1). ________________________________________________________________________________________________________ 5. Has the issuer previously sold securities in Missouri? If yes, please describe and explain how these sales complied with the Missouri securities laws. 6. Please describe the offering as follows: Offering Price or Proposed Offering Price No. of Shares or Units Total Offering Amount $ Offering in This State No. of Shares or Units Amount $ Description of Securities FORM SE-1 (01/2017) Totals $ $ American LegalNet, Inc. www.FormsWorkFlow.com 7. List the states in which the issuer is intending to offer its securities for sale to the public. 8. Has any person received commissions or other remuneration in connection with the offer or sale of securities of the issuer? If yes, please provide for each person, his name, address, telephone number and description of the commissions or other remuneration. 9. List all promoters, officers and directors of the issuer, including their address, position with the issuer and beginning date with the issuer. 10. Describe the method by which the securities described above will be sold, including any class of persons to whom offers will be made and the geographic areas in which sales activities will be conducted. 11. The following documents must be submitted as a part of this statement of claim: (a) (b) (c) (d) (e) (f) (g) Consent to service of process. Corporate resolution. Prospectus or offering document in its latest form. Bylaws, operating agreement or similar document. Any advertising materials or any summaries of the offering document to be used in the offer or sale of the securities. Underwriting or selling agreements. Subscription agreements. Date ___________________________________ __________________________________________________ By ______________________________________________ Name and Title Name of Issuer FORM SE-1 (01/2017) American LegalNet, Inc. www.FormsWorkFlow.com STATE OF _____________________________ County of ______________________________ The undersigned, __________________________________________________ , being first duly sworn, deposes and says: } ss. of such issuer and is fully authorized to execute and file such statement of claim; that he is familiar with such statement of claim; and that to the best of his knowledge, information and belief the statements made in such statement of claim are true and the documents submitted therewith are true copies of the originals thereof. That he has executed the foregoing statement of claim for and on behalf of the issuer named therein, that he is _____________ Subscribed and sworn to before me, this day of , 20 Notary Public Name , In and for the County of State of (Notary Seal) My Commission Expires: FORM SE-1 (01/2017) American LegalNet, Inc. www.FormsWorkFlow.com