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Registration By Qualification For Government Or Quasi Governmental Bond Issues Form. This is a Washington form and can be use in Blue Sky Secretary Of State.
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Tags: Registration By Qualification For Government Or Quasi Governmental Bond Issues, Washington Secretary Of State, Blue Sky
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
STATE OF WASHINGTON
Department of Financial Institutions
:
Securities Division
PO Box 9033
Olympia, WA 98507-9033:
Plaintiff(s)
360-902-8760
-against-
Index No.
Calendar No.
JUDICIAL SUBPOENA
:
REGISTRATION BY QUALIFICATION FOR
:
GOVERNMENT OR QUASI-GOVERNMENTAL BOND ISSUES
:
1. Name and address of registrant ____________________________________________________________________
Defendant(s)
:
......................................................
______________________________________________________________________________________________
2. Name and address of issuer or user of proceeds _______________________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
______________________________________________________________________________________________
3. Short description of securities to be qualified __________________________________________________________
TO
______________________________________________________________________________________________
4. Number of securities to be offered in Washington ______________________________________________________
GREETINGS:
5. Number of securities to be offered in all states ________________________________________________________
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
the Honorable security _______________________________________________________________________ ,
at the
Court
6. Maximum price per
located at
County of
7. Fee ($100.00 for the , on the
first $100,000dayinitial issue, or portion thereof in this state,in the on the offeringat any recessed
of of
in room
, 20
, at
o'clock based
noon, and price, plus
1/20 adjournedany excess over $100,000 which are a witness in this action on the part of the
of 1% for date, to testify and give evidence as to be offered during that year).
or
_________________________________________________________________________________________________
NOT LESS THAN $100.00
8. Fiscal year ends ________________________________________________________________________________to
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
9. Name, address, and phone number of person to contact who is responsible for this filing _______________________
______________________________________________________________________________________________
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
__________________________________________
By __________________________________________
STATE OF WASHINGTON
Country of _________________________
(Attorney must sign above and type name below)
______________________________________________________________, being first duly sworn, deposes and says;
I have been authorized by the registrant to execute and file the foregoing statement. I have read the statement and the
exhibits filed with it, and the facts stated in the statement and in the exhibits are true to the best of my knowledge,
Attorney(s) for
information and belief.
_______________________________________
AFFIANT
Sworn to before me this __________ day of ___________, 20 _____. Office and P.O. Address
__________________________________________
Telephone No.:
Facsimile No.:
E-Mail Address:
My commission expires ______________________
Mobile Tel. No.:
Residing at ________________________________
SC-610-039 GOV. & QUASI-GOV. (R/7/90) Page 1 of 4
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