Issuer-Dealer Notice Filing Application
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Issuer-Dealer Notice Filing Application Form. This is a New Hampshire form and can be use in Securities Secretary Of State.
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Tags: Issuer-Dealer Notice Filing Application, D-4, New Hampshire Secretary Of State, Securities
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
STATE OF NEW HAMPSHIRE Calendar No.
DEPARTMENT OF STATE
:
BUREAU OF Plaintiff(s)
SECURITIES REGULATION
JUDICIAL SUBPOENA
-against-
Form D-4
:
No.
:
Rec'd
:
App'd
Fee
Defendant(s)
:
......................................................
Granted
Issuer-Dealer Notice Filing Application
THE PEOPLE OF THE STATE OF NEW YORK
1. Name of Issuer
. (give full name)
TO
2. Business Address
.
(Street and Number or PO Box)
3. State GREETINGS:
of Formation
(Town)
(Zip)
.
4. Description of Securities Sold
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
the Honorable
at the
Court
. ,
(Include price per unit, type, and aggregate value)
located at
County of
, on the
day of
, at
o'clock in the
noon, and at any recessed
5. Date in room sale
of first
., 20
or adjourned date, to testify and give evidence as a witness in this action on the part of the
6. Name or names of the representative or representatives of the issuer who are engaged in the sale of the
securities
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 any such agent has
7. Indicate whether failure to comply. been convicted of a felony and include the date and place of the
conviction
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
.
, 20
No license will be issued until all blanks in this form are properly filled out. The application shall be
signed by that person or persons who are authorized to do so by the issuer's board of directorsbelow)
or other
(Attorney must sign above and type name
governing body.
Attorney(s) for
Signed
Dated
Notarized:
STATE OF
COUNTY OF
Subscribed and sworn to me before this
Notary Public
Office and P.O. Address
day of
,
Telephone No.:
Facsimile No.:
E-Mail Address:
Date of ExpirationMobile Tel. No.:
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