Registration By Notification (Non-Issuer Distribution)
Registration By Notification (Non-Issuer Distribution) Form. This is a Virginia form and can be use in Blue Sky Secretary Of State.
Tags: Registration By Notification (Non-Issuer Distribution), S.A. 5, Virginia Secretary Of State, Blue Sky
S.A.5 (Rev. 11/96) COMMONWEALTH OF VIRGINIA STATE CORPORATION COMMISSION DIVISION OF SECURITIES AND RETAIL FRANCHISING REGISTRATION BY NOTIFICATION Non-Issuer Distribution 1. Name and address of issuer:____________________________________________________ __________________________________________________________________________ 2. Description of the securities and total amount to be offered ___________________________ __________________________________________________________________________ 3. Number of securities to be offered in Virginia______________________________________ 4. Maximum price per security ___________________________________________________ 5. Fee (1/20 of 1% of the maximum offering price of the securities to be offered in this state; but such fee shall not be less than $100 nor more than $250.) __________________________________________________________________________ 6. Are the offer and sale of the securities hereby directly or indirectly for the benefit of the issuer? __________________________________________________________________________ 7. Have securities of the same class as the security being registered previously been registered in Virginia? __________________________________________________________________________ If so, give the date of registration and the name of the person by whom they were registered. __________________________________________________________________________ 8. Were the securities being registered originally issued pursuant to an exemption under § 13.1514? ______________ If so, state which exemption. __________________________________________________________________________ The registrant, after investigation, believes that the facts herein stated are true. _____________________________________________ By __________________________________________ Address ______________________________________ Date:______________________ _____________________________________________ American LegalNet, Inc. www.USCourtForms.com S.A.5 (Rev. 11/96) INSTRUCTIONS 1. This statement must be accompanied by the fee shown on line 5, payable to the Treasurer of Virginia. 2. Unless of the registrant is notified to the contrary by the State Corporation Commission, the registration becomes effective on 3 P.M. on the second full business day after the statement has been filed in the office of the Commission, if the statement is complete and states facts showing eligibility of the securities for registration by notification. If the statement is incomplete, the registration is not effective until after the last amendment thereto has been filed. 3. Securities issued before January 1, 1957, stand on the same footing as securities issued after that date for the purpose of determining whether they were issued pursuant to an exemption in §13.1-514. American LegalNet, Inc. www.USCourtForms.com