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Accredited Investor Exemption Uniform Notice Of Transaction Form. This is a Utah form and can be use in Blue Sky Department Of Commerce.
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Tags: Accredited Investor Exemption Uniform Notice Of Transaction, 14-25S, Utah Department Of Commerce, Blue Sky
Page 1 of 2
(Rev. 11/16/98)
STATE OF UTAH
DEPARTMENT OF COMMERCE
DIVISION OF SECURITIES
FORM 14-25s
Accredited Investor Exemption
Uniform Notice of Transaction
Notice of Sale of Securities pursuant to Accredited Investor Exemption
1. Issuer:
Name:
Address:
Telephone Number:
2. Form of Organization: (check one)
9Corporation
9Unincorporated Association
9Limited Partnership
9Limited Liability Company
9Other (specify) ______________________________________
Issuer’s state or jurisdiction of Incorporation or Organization: ______________________
Date of Incorporation or Organization: ________________________________________
3. Officers and Directors: (or persons acting in a similar capacity)
Names, Business Addresses, and Business Phone Numbers
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________
4. This Offering:
Description of
Security
Price per
Security
Number of Securities
to be Offered
Aggregate dollar
Amount of Offering
Debt
Equity (Common or
Preferred)
Convertible Security
Partnership Interests
Other (Specify)
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Form 14-25s
Page 2of 2
(Rev. 11/16/1998)
5. Description of Business:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
___________________________________________________________________
6. Name and Business Address of any Broker-Dealer who has solicited or intends to solicit
purchasers in Utah:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
By filing this Notice of Transaction, the Issuer of these securities understands that:
(1)
Sales of securities shall be made only to persons whom the issuer reasonably believes
are accredited investors as defined in 17CFR 230.501(a).
(2)
The issuer is not an issuer in the development stage that either has no specific business
plan or purpose or has indicated that its business plan is to engage in a merger or
acquisition with an unidentified company or companies, or other entity or person.
(3)
The issuer reasonably believes that all purchasers are purchasing for investment and
not with the view to or for sale in connection with a distribution of the security. Any
resale of a security sold in reliance on this exemption within 12 months of sale shall
be presumed to be with a view to distribution and not for investment, except a resale
pursuant to an effective registration statement or to an accredited investor pursuant
to an available exemption.
The undersigned represents that the issuer is familiar with the conditions that must be satisfied to be
entitled to the Accredited Investor Exemption of Utah in which this notice is filed and understands
that the issuer claiming the availability of this exemption has the burden of establishing that these
conditions have been satisfied.
The issuer has read this notification and knows the contents to be true and has duly caused this notice
to be signed on its behalf by the undersigned duly authorized person.
___________________________
Issuer (Print or type)
_________________________________
Signature
___________________________
Name (Print or type)
____________
Date
_________________________________
Title
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