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Application For License For New Hampshire Issuer-Dealer Form. This is a New Hampshire form and can be use in Securities Secretary Of State.
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Tags: Application For License For New Hampshire Issuer-Dealer, D, New Hampshire Secretary Of State, Securities
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index D
New Hampshire Form No.
No. ____________________________
:
Calendar No.
STATE OF NEW HAMPSHIRE
Rec'd __________________________
DEPARTMENT OF STATE
App'd __________________________
:
JUDICIAL SUBPOENA
BUREAU OF SECURITIES REGULATIONPlaintiff(s)
Fee ____________________________
Granted ________________________
-against:
:
Application for License for New Hampshire Issuer-Dealer
:
To the Secretary of State
Defendant(s)
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . for . . . . . . . . . . . . . .
The undersigned . .hereby. .applies . . . . . . a. .license . authorizing it to sell its securities
in this state under the New Hampshire Blue Sky Law and makes the following statement:
1. Name of applicant
2. Address of applicant
THE PEOPLE OF
3. Telephone No. THE STATE OF NEW YORK
4. Date of incorporation or organization, and place:
TO
5. (a) Type of Organization:
Corporation
Partnership/LLP
Proprietorship
Other
LLC
6. Are you actually engaged in business in this state?
7. Give the names, residences, business addresses, capacity and title of all persons
GREETINGS:
interested in the business as principals, officers, directors, managers or managing
agents.
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Name Honorable Residence
Business Address
Capacity and Title
,
the
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
8. Inthe partyother states this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
what on whose behalf have you ever applied for a securities license?
result of your failure to comply.
9.
In what other state are you licensed or registered?
Witness, Honorable
, one of the Justices of the
10.State briefly the general plan and character of the business of applicant,
Court in
County,
day of
20
specifying the nature of property in which , it is proposed to deal,and the method of
transacting business, whether by solicitation, advertisement, correspondence or
otherwise.
(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.:
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
11.Type and amount of securities for which qualification is requested
:
:
There are attached hereto and made a part hereof:
Index No.
Calendar No.
:
(a) Copy of charter, articles of incorporation, or limited liability company, or limited partnership
JUDICIAL
Plaintiff(s)
agreement certified by proper state official.
-against-
SUBPOENA
:
(b) Copy of by-laws certified by Clerk of the Corporation
:
(c) Certified copies of Profit and Loss Statement and Balance Sheet as of
last December 31, or close of fiscal year.
:
(d) Pro-forma Balance Sheet (if new entity with no operating history).
Defendant(s)
:
......................................................
(e) Copy of offering memorandum or prospectus.
(f) Three references as to the business repute and character of applicant,
from unaffiliated persons, including names, addresses, and telephone numbers.
THE PEOPLE OF THE STATE OF NEW YORK
(g) Form D-1, properly executed, by each of the persons signing below.
TO
(h) There is enclosed herewith the fee due on filing this application.
(Corporate seal if incorporated)
GREETINGS:
THIS APPLICATION MUST BE SIGNED BY ALL THE OFFICERS, PRINCIPALS, DIRECTORS, MANAGERS, MANAGING
AGENTS, OR PARTNERS OF THE CORPORATION OR OTHER LEGAL ENTITY.
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
at the
Court
(Sign here) Honorable
the
1.___________________________________
located at
County of
Date
5._________________________________________
Date
2._____________________________________
Date
6._________________________________________
Date
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
DOB
SS#
DOB
SS#
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
DOBthe party on whose behalf this subpoena was issued for aDOB
SS#
maximum penalty of SS# and all damages sustained as a
$50
result of your failure to comply.
3._____________________________________
Date
Witness, Honorable
DOBCourt in
SS# County,
7_________________________________________
Date
, one of the Justices of the
day of
4._____________________________________
Date
, 20
DOB
SS#
8.________________________________________
Date
(Attorney must sign above and type name below)
DOB
SS#
DOB
SS#
Attorney(s) for
STATE OF
COUNTY OF
Subscribed and sworn to before me this
day of
,
Office and P.O. Address
_________________________________________
Notary Public
Telephone No.:
My commission expires
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
