Intrastate Exemption Notice Form. This is a Texas form and can be use in Blue Sky Secretary Of State.
Tags: Intrastate Exemption Notice, 133.29, Texas Secretary Of State, Blue Sky
Form 133.29 Texas State Securities Board P.O. Box 13167 Austin, Texas 78711-3167 Intrastate Exemption Notice (§109.13(l)) This form is used to notify the Texas State Securities Board of an issuer's intent to sell securities under §109.13(l). All answers required by this form must be completed and this form must be submitted to the Texas State Securities Board at least 10 business days before any sale may be consummated under §109.13(l). Where needed, please attach answers on a separate sheet of paper and number answers to correspond to the numbers on this Form. Name of issuer: Contact persons and telephone numbers: State of organization: Address of principal place of business: 1. Description of the issuer's plan of business: 2. Information on securities to be sold: (a) Description of securities to be sold (including title and class): 08-16-2010 American LegalNet, Inc. www.FormsWorkFlow.com Form 133.29 (b) (c) (d) 3. Total number of shares or units proposed to be sold: Offering price per unit at which the securities are to be sold: Aggregate dollar amount of securities to be sold: Section 35 of the Texas Securities Act requires payment of a fee that is equal to one-tenth of one percent (1/10 of 1%) of the aggregate amount of securities described as being offered for sale, but in no case more than $500. Please indicate the amount of fees remitted. List present officers, directors, partners, members, trustees or managers. Give complete names, dates of birth, home addresses, and business addresses: 4. 5. List all persons who will actually engage in selling securities. Give complete names, dates of birth, and addresses: 6. State whether the issuer or the registered dealer (as such terms are defined in §109.13(l)): (a) is currently subject to any administrative order issued by state or federal authorities within 5 years of the expected offer and sale of securities in reliance upon this exemption, and the order: (1) (2) is based upon a finding that such person has engaged in fraudulent conduct; or has the effect of enjoining such person from activities governed by federal or state statutes designed to protect investors or consumers against unlawful or deceptive practices involving securities, insurance, commodities or commodity futures, real 08-16-2010 American LegalNet, Inc. www.FormsWorkFlow.com Form 133.29 estate, franchises, business opportunities, consumer goods, or other goods and services. G No G Yes If yes, give details in an attached statement, including pertinent dates, style and number of case, and disposition of case. (b) has been convicted within 5 years prior to commencement of the offering: (1) of any felony or misdemeanor of which fraud is an essential element, or which is a violation of the securities laws or regulations of this state, any other state of the United States, the United States, or any foreign jurisdiction; of a crime involving moral turpitude; or of a criminal violation of statutes designed to protect consumers against unlawful practices involving insurance, securities, commodities or commodity futures, real estate, franchises, business opportunities, consumer goods or other goods and services. (2) (3) G No G Yes (c) If yes, give details in an attached statement, including identification of court, style and number of case, charge, and disposition of case. is subject to any order, judgment or decree entered within 5 years prior to commencement of the offering by any court of competent jurisdiction which: (1) temporarily or permanently restrains or enjoins such person from engaging in or continuing any conduct or practice in connection with the purchase or sale of any security or involving any false filing with any state; or restrains or enjoins such person from activities governed by federal or state statutes designed to protect consumers against unlawful or deceptive practices involving insurance, commodities or commodity futures, real estate, franchises, business opportunities, consumer goods, or other goods and services. (2) G No G Yes If yes, give details in an attached statement, including identification of court, style and number of case, and disposition of case. 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 issuer named therein; that he or she is the of such issuer and is fully authorized to execute and file such application; that he or she is familiar 08-16-2010 American LegalNet, Inc. www.FormsWorkFlow.com Form 133.29 with such application; and that to the best of his or her knowledge, information and belief the statements made in such application are true and any documents submitted therewith are true copies of the originals thereof. (Signature) (Printed name) 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 08-16-2010 American LegalNet, Inc. www.FormsWorkFlow.com