NEW JERSEY BUREAU OF SECURITIES 153 Halsey Street, 6th Floor PO Box 47029 Newark, NJ 07101 (973) 504-3600 NEW JERSEY REGISTRATION STATEMENT FOR REGISTRATION BY NOTIFICATION All items must be answered. Attach riders where necessary. I. DESCRIPTION OF ISSUER A. Name: ________________________________________________________________ B. Address: ______________________________________________________________ C. Form of organization: State: ___________________________________________________ Date organized: ___________________________________________ D. General character of business: _____________________________________________ ______________________________________________________________________ E. Principal place of business: _______________________________________________ ______________________________________________________________________ II. DESCRIPTION OF SUBSIDIARIES (State the information requested in Question I for each significant subsidiary of the issuer.) __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ III. DESCRIPTION OF APPLICANT (Complete if applicant is not the issuer.) A. Name: ________________________________________________________________ B. Address: ______________________________________________________________ C. Relationship to issuer: ___________________________________________________ American LegalNet, Inc. www.USCourtForms.com Page 2 IV. INFORMATION REGARDING NONISSUER DISTRIBUTION (Complete only if offering or any part thereof is for the benefit of selling securityholders.) A. Name of each person on whose behalf any part of the offering is to be made: _______ _____________________________________________________________________ _____________________________________________________________________ B. Address(es): __________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ C. Amount of securities currently held by each selling securityholder: _______________ _____________________________________________________________________ _____________________________________________________________________ D. Reason (purpose) for making this offering: __________________________________ _____________________________________________________________________ _____________________________________________________________________ V. DESCRIPTION OF SECURITIES Description of securities Offering price or proposed offering price Total offering # of shares $ of shares or units or units Offering in this state # of shares $ of shares or units or units ____________ ___________ _________ _________ _________ _________ ____________ ___________ _________ _________ _________ _________ ____________ ___________ _________ _________ _________ _________ ____________ ___________ _________ _________ _________ _________ Totals _________ _________ _________ _________ American LegalNet, Inc. www.USCourtForms.com Page 3 VI. INFORMATION AND DOCUMENTS REQUIRED A. States in which a registration statement or similar document in connection with this offering has been or is to be filed. ___________________________________________________ ________________________________________________________________________ B. State whether any withdrawal or any adverse order, judgment, or decree has been entered in connection with this offering by the regulatory authorities in any state or by any court or by the Securities and Exchange Commission. _____________________________________ If so, give details. _________________________________________________________ ________________________________________________________________________ C. (1). Proposed offering price per unit (or the method by which it is to be computed). ____________________________________________________________________ ____________________________________________________________________ (2). State whether the price will vary as to any person or class of persons other than underwriters. _________________________________________________________ If so, give details. _____________________________________________________ ____________________________________________________________________ (3). Is this offering, or any part thereof, to be made other than for cash? ______________ If so, give details. _____________________________________________________ ____________________________________________________________________ D. (1). Estimated aggregate underwriting and selling discounts or commissions and finder’s fees. Show each means of payment separately (e.g., cash, securities, contracts). _________ ____________________________________________________________________ (2). If the selling discounts and commissions are variable, state the basis of determining them, American LegalNet, Inc. www.USCourtForms.com Page 4 including their maximum and minimum amount. _____________________________ ____________________________________________________________________ (3). State the estimated amounts of other selling expenses, including legal, engineering and accounting expenses. ___________________________________________________ ____________________________________________________________________ E. (1). The name and address of every underwriter, agent, broker-dealer or other recipient of a commission, discount or finder’s fee. (Submit the underwriting agreement or form of underwriting agreement as an exhibit.) _____________________________________ ____________________________________________________________________ (2). If the securities are not to be offered through an underwriter, describe the plan of distribution. ____________________________________________________________ ____________________________________________________________________ (3). Identify the agent or broker-dealer registered in New Jersey who will offer the securities or state the applicable exemption. _________________________________________ ____________________________________________________________________ F. Description of any stock options outstanding or to be created in connection with this offering. ____________________________________________________________________ ____________________________________________________________________ G. List dollar amounts of options held by each of the following: Name and address 1. Each director or officer of the issuer or person occupying a similar status. Dollar amount of options held __________________________ ____________ __________________________ ____________ American LegalNet, Inc. www.USCourtForms.com __________________________ Page 5 ____________ __________________________ ____________ __________________________ ____________ __________________________ ____________ __________________________ ____________ 4. If this is a nonissuer distribution, __________________________ any person on whose behalf this offering is to be made. __________________________ ____________ 5. Every underwriter or recipient of __________________________ a finder’s fee (every person listed in paragraph E). __________________________ ____________ 6. Every person who holds or will __________________________ hold 10% or more in the aggregate of such options. __________________________ ____________ 2. Any person owning of record, or beneficially if known, at least 10% of the outstanding shares of any class of equity security of the issuer. 3. Every promoter of the issuer if the issuer was organized within the past 3 years. ____________ ____________ ____________ H. EXHIBITS Submitted herewith as part of this registration statement are the following documents. (Documents on file may be incorporated by reference.) 1. A statement of eligibility for registration by notification. 2. A copy of the underwriting or selected dealer agreement (or the proposed form). 3. A copy of any prospectus, pamphlet, circular, form letter, advertisement, or other sales literature intended to be used in connection with this offering. 4. A consent to service of process of the issuer (with appropriate resolution). 5. The New Jersey Addendum. 6. Financial statements pursuant to N.J.S.A. 49:3-61.2(b)(6), specifically: (a) A balance sheet of issuer as of a date within 4 months prior to the filing of this registration statement; and (b) A summary of earnings for each of the 2 fiscal years preceding the date of the balance sheet, and summary of earnings for any period between the close of the last fiscal year and American LegalNet, Inc. www.USCourtForms.com Page 6 the date of the balance sheet, or for the period of the issuer’s and any predecessor’s existence if less than 2 years. 7. The registration fee of $1,000.00. ________________________________ Name of Applicant By: _____________________________ (Name and Title) DATE: ____________________________ STATE OF _________________________ COUNTY OF _______________________ The undersigned, ____________________________, being first duly sworn, deposes and says: That he has executed the foregoing application for and on behalf of the applicant named therein; that he is ______________________________ of such applicant and is fully authorized to execute and file such application; that he is familiar with such application; and that to the best of his knowledge, information and belief the statements made in such application are true and the documents submitted therewith are true copies of the originals thereof. __________________________________ Name Subscribed and sworn to before me this _____ day of ______________, 20___ ___________________________________ ___________________________________ NOTARY PUBLIC In and for the County of _______________ State of ____________________________ My Commission Expires: ______________ (Notarial Seal) Form NJBOS-6 9/2003 American LegalNet, Inc. www.USCourtForms.com