Application For Renewal Permit Form. This is a Texas form and can be use in Blue Sky Secretary Of State.
Tags: Application For Renewal Permit, 133.13, Texas Secretary Of State, Blue Sky
Form 133.13 TEXAS PERMIT NO. EXPIRATION DATE Texas State Securities Board P.O. Box 13167 Austin, Texas 78711-3167 Application for Renewal Permit Must be submitted with the applicable renewal fee. This application may be completed by the Issuer or by a registered dealer. Each of the following items must be completed to effect a renewal permit. 1. Name of Issuer: 2. Principal office of Issuer: 3. Issuer’principal office in Texas (if any): s 4. Correspondent: Firm: Address: Telephone: ( ) 5. Issuer’form of organization (e.g., corporation, trust, partnership, etc.): s 6. State of incorporation (if applicable): 7. Date of incorporation (if applicable): 8. Describe any legal or administrative proceedings of a material nature that have been instituted in which the Issuer, its advisor, or any affiliate was named as a party. If you have not previously notified the State Securities Board of such proceedings, please attach a summary or copy of the pleadings. A-22 02-24-2004 American LegalNet, Inc. www.USCourtForms.com Form 133.13 9. Describe the securities registered in Texas (e.g., quantity, type, price per unit, offering price): 10. Number of shares and dollar amount of securities sold in Texas under current permit: For the period from: to: 11. Number of shares and dollar amount of securities sold elsewhere under current permit: For the period from to: 12. Is the renewal fee enclosed? Yes ( ) No ( ) If this fee is not enclosed, a renewal permit will not be issued. 13. Submit one copy of each of the following exhibits: (a) opinion of independent, certified or public accountant; (b) the most recent financial statement required by the applicable provisions of the Texas Securities Act, Section 7. If these statements are as of a date more than 90 days prior to the permit expiration date, interim statements as of a date within the 90-day period should be filed; (c) up-to-date current prospectus including all material changes and current financial statements as described in (b) above; and (d) if the Issuer is a corporation, certify that payment of franchise taxes owed to the State of Texas is current. If the Issuer is a corporation exempt from the payment of franchise taxes, or an out-of-state corporation that is not subject to Texas franchise taxes, certify to that effect. Signed and sealed this day of , 20__________ (Name of applicant) By: (Title) Attest: (Secretary or Partner) A-23 02-24-2004 American LegalNet, Inc. www.USCourtForms.com Form 133.13 STATE OF COUNTY OF The undersigned being duly sworn deposes and says that he or she has executed the foregoing application for and on behalf of the applicant named therein; that he or she is (title) of such applicant and is fully authorized to execute and file such application; that he or she is familiar with such application; and to the best of his or her knowledge, information, and belief the statements made in such application are true and the documents submitted herewith are true copies of the originals thereof. The undersigned further deposes and says that unless the State Securities Board has been notified otherwise, no legal or administrative proceedings of a material nature have been instituted in which the Issuer, its advisor, or any affiliate thereof was a party since publication of the Issuer’ s most recent prospectus. (Signature) (Capacity) Subscribed and sworn to before me the day of , 20 _______ Notary Public in and for the County of State of (NOTARY SEAL) My commission expires: A-23A 02-24-2004 American LegalNet, Inc. www.USCourtForms.com