(Department of Business Oversight Use Only) | DEPARTMENT OF BUSINESS OVERSIGHT FILE NO., if any: | |
___________________________Fee paid $ | ___________________________ | |
___________________________ | ___________________________ | |
___________________________Receipt No. | Insert File number(s) of Previous Filings Before the Department, if any. |
FEE: $25.00 $35.00 $50.00 $150.00 $300.00
(Circle the appropriate amount of fee. See Corporations Code Section 25608(c))
COMMISSIONER OF BUSINESS OVERSIGHT STATE OF CALIFORNIA
NOTICE OF TRANSACTION PURSUANT TO CORPORATIONS CODE SECTION 25102(f)
ELECTRONIC FILING REQUIREMENT AND HARDSHIP EXCEPTION:
This notice must be filed electronically through the Internet process made available by the Department of Business Oversight at www.dbo.ca.gov, unless the issuer claims the hardship exception as described in Number 8 below.
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Street | City | State | Zip | |
Mailing Address: | ||||
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Street | City | State | Zip |
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California | Total Offering | ||
(a)(i) in money | ___________________________$ | ___________________________$ | |
(ii) in consideration other than money | ___________________________$ | ___________________________$ | |
(iii) total of (i) and (ii) | ___________________________$ | ___________________________$ |
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[] Computer equipment including hardware and software is unavailable to the issuer without unreasonable burden or expense. If this is the case, describe below both of the following; the reason(s) that the computer equipment including hardware and software is unavailable without unreasonable burden or expense, and the description(s) of the unreasonable burden or expense.
[] The issuer cannot obtain and provide information (including credit card or other identifying information) requested on the Department's electronic notice or through the Internet filing process. If this is the case, describe below both of the following: the reason(s) that the issuer cannot obtain and provide the requested information on the electronic notice or through the Internet filing process without unreasonable burden or expense, and the description(s) of the unreasonable burden or expense to the issuer to make the electronic filing.
After checking the applicable hardship exception above, the issuer shall describe below the reason(s) and description(s) for that hardship exception. (If additional space is needed, attach a separate sheet to this notice.)
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Authorized Signature on behalf of issuer
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Print name and title of signatory
________________________________________
Date
Name, Address and Phone number of contact person:
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COMMISSIONER OF BUSINESS OVERSIGHT STATE OF CALIFORNIA NOTICE OF TRANSACTION PURSUANT TO CORPORATIONS CODE SECTION 25102(f) INSTRUCTIONS
Value of Securities | Filing Fee | |
$25,000 or less | $25 | |
$25,001-$100,000 | $35 | |
$100,001-$500,000 | $50 | |
$500,001-$1,000,000 | $150 | |
Over $1,000,000 | $300 |
Filing Fee: Each notice, whether under 25102(f) or Rule 260.103, must be accompanied by the filing fee required by Section 25608(c) of the Code as described above.
Item A. Check appropriate box for exemption being relied on.
Item 1. Give the issuer's legal name.
Item 2. Give the street address, and the mailing address if different, of the issuer's principal place of business.
Item 3. Give the telephone number of issuer's principal place of business.
Item 4. Give the name of the state or other jurisdiction under whose laws the issuer is incorporated or organized. If the issuer is not incorporated or organized under the laws of any jurisdiction, provide the name of the jurisdiction where issuer is domiciled and include parenthetical "(domicile)."
Item 5. Set forth the name or title of each class or type of security to be sold in the transaction.
Item 6. See Corp. Code sec. 25608(g). Generally, the value of the securities shall be the price at which the issuer proposes to sell the securities, as alleged in the notice, or the actual value of the consideration (if other than money) to be received in exchange for the securities. See sec. 25608(g) for valuing voting trust certificates, warrants, rights, and share dividends. Complete the amounts in (a)(i), (ii) and (iii) in both the California and the Total Offering columns.
Item 7. If the transaction was registered under the Securities Act of 1933, insert "Registration Statement". If conducted pursuant to an exemption from registration under that Act which requires a filing with the Securities and Exchange Commission, indicate the number of the rule pursuant to which such filing was made. If no such filing was made, insert "none."
Item 8. If the notice is not filed electronically through the Internet process made available by the Department at www.dbo.ca.gov, then complete the hardship exception by checking the applicable box and describing the reason(s) and description(s) for the hardship exception, as specified.
Item 9. Consent to Service of Process. Corporations Code section 25165 requires each issuer, other than a California corporation, to file a consent to service of process with the notice filed pursuant to section 25102(f) unless it already has a consent to service on file with the Commissioner. If the issuer already has a consent to service of process on file with the Commissioner, check the box. If no consent to service of process is on file with the Commissioner, attach the consent to this notice. Use Form 260.165 (see Rule 260.165, Title 10, California Code of Regulations).
Item 10. Date, Signature and Contact. The notice shall be signed and dated by an authorized officer, director, general partner or trustee of the issuer (or a person occupying a position with the issuer of equivalent responsibility) or by the authorized attorney of the issuer. If the person the Department is to contact in the event of questions concerning the transaction or the notice is different than the signer, insert the contact person's name, telephone number and correspondence address in the spaces provided. Otherwise, provide this information with respect to the signer.
The following shall apply to any person filing electronically:
Cal. Code Regs. Tit. 10, § 260.102.14
2. Certificate of Compliance including amendment transmitted to OAL 2-22-82 and filed 3-24-82 (Register 82, No. 13).
3. Amendment of subsection (a)(1) filed 10-15-82; effective thirtieth day thereafter (Register 82, No. 42).
4. Editorial correction of subsection (d) to correct printing error (Register 83, No. 11).
5. Amendment filed 9-30-83 as an emergency; effective upon filing (Register 83, No. 40). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 1-28-84.
6. Certificate of Compliance including amendment as to 9-30-83 order transmitted to OAL 1-25-84 and filed 2-16-84 (Register 84, No. 7).
7. Amendment filed 9-21-84; effective thirtieth day thereafter (Register 84, No. 38).
8. Editorial correction of Form Reference (Register 91, No. 24).
9. New subsections (e)-(e)(5) filed 7-3-2003 as an emergency; operative 7-4-2003 (Register 2003, No. 27). A Certificate of Compliance must be transmitted to OAL by 11-3-2003 or emergency language will be repealed by operation of law on the following day.
10. New subsections (e)-(e)(5) refiled 10-31-2003 as an emergency; operative 11-3-2003 (Register 2003, No. 44). A Certificate of Compliance must be transmitted to OAL by 3-2-2004 or emergency language will be repealed by operation of law on the following day.
11. Amendment of section and NOTE filed 1-16-2004 as an emergency; operative 1-16-2004 (Register 2004, No. 3). A Certificate of Compliance must be transmitted to OAL by 5-17-2004 or emergency language will be repealed by operation of law on the following day.
12. Certificate of Compliance as to 10-31-2003 order, including amendment of subsection (e) and new subsection (e)(6), transmitted to OAL 3-2-2004 and filed 4-13-2004 (Register 2004, No. 16).
13. Amendment of section and NOTE refiled 5-17-2004 as an emergency; operative 5-17-2004 (Register 2004, No. 21). A Certificate of Compliance must be transmitted to OAL by 9-14-2004 or emergency language will be repealed by operation of law on the following day.
14. Certificate of Compliance as to 5-17-2004 order, including further amendment of section and NOTE, transmitted to OAL 9-14-2004 and filed 10-27-2004 (Register 2004, No. 44).
15. Amendment of subsections (a)(2) and (c)-(e), new subsection (f) and new NOTE filed 6-22-2005; operative 7-22-2005 (Register 2005, No. 25).
16. Amendment of subsections (a)(2), (c) and (d) filed 9-24-2009; operative 10-24-2009 (Register 2009, No. 39).
17. Change without regulatory effect amending subsections (a)(2), (c) and (d) filed 8-13-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 33).
Note: Authority cited: Sections 25102, 25165 and 25610, Corporations Code. Reference: Sections 25102, 25165, 25608 and 25620, Corporations Code.
2. Certificate of Compliance including amendment transmitted to OAL 2-22-82 and filed 3-24-82 (Register 82, No. 13).
3. Amendment of subsection (a)(1) filed 10-15-82; effective thirtieth day thereafter (Register 82, No. 42).
4. Editorial correction of subsection (d) to correct printing error (Register 83, No. 11).
5. Amendment filed 9-30-83 as an emergency; effective upon filing (Register 83, No. 40). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 1-28-84.
6. Certificate of Compliance including amendment as to 9-30-83 order transmitted to OAL 1-25-84 and filed 2-16-84 (Register 84, No. 7).
7. Amendment filed 9-21-84; effective thirtieth day thereafter (Register 84, No. 38).
8. Editorial correction of Form Reference (Register 91, No. 24).
9. New subsections (e)-(e)(5) filed 7-3-2003 as an emergency; operative 7-4-2003 (Register 2003, No. 27). A Certificate of Compliance must be transmitted to OAL by 11-3-2003 or emergency language will be repealed by operation of law on the following day.
10. New subsections (e)-(e)(5) refiled 10-31-2003 as an emergency; operative 11-3-2003 (Register 2003, No. 44). A Certificate of Compliance must be transmitted to OAL by 3-2-2004 or emergency language will be repealed by operation of law on the following day.
11. Amendment of section and Note filed 1-16-2004 as an emergency; operative 1-16-2004 (Register 2004, No. 3). A Certificate of Compliance must be transmitted to OAL by 5-17-2004 or emergency language will be repealed by operation of law on the following day.
12. Certificate of Compliance as to 10-31-2003 order, including amendment of subsection (e) and new subsection (e)(6), transmitted to OAL 3-2-2004 and filed 4-13-2004 (Register 2004, No. 16).
13. Amendment of section and Note refiled 5-17-2004 as an emergency; operative 5-17-2004 (Register 2004, No. 21). A Certificate of Compliance must be transmitted to OAL by 9-14-2004 or emergency language will be repealed by operation of law on the following day.
14. Certificate of Compliance as to 5-17-2004 order, including further amendment of section and Note, transmitted to OAL 9-14-2004 and filed 10-27-2004 (Register 2004, No. 44).
15. Amendment of subsections (a)(2) and (c)-(e), new subsection (f) and new Note filed 6-22-2005; operative 7-22-2005 (Register 2005, No. 25).
16. Amendment of subsections (a)(2), (c) and (d) filed 9-24-2009; operative 10-24-2009 (Register 2009, No. 39).
2. Certificate of Compliance including amendment transmitted to OAL 2-22-82 and filed 3-24-82 (Register 82, No. 13).
3. Amendment of subsection (a)(1) filed 10-15-82; effective thirtieth day thereafter (Register 82, No. 42).
4. Editorial correction of subsection (d) to correct printing error (Register 83, No. 11).
5. Amendment filed 9-30-83 as an emergency; effective upon filing (Register 83, No. 40). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 1-28-84.
6. Certificate of Compliance including amendment as to 9-30-83 order transmitted to OAL 1-25-84 and filed 2-16-84 (Register 84, No. 7).
7. Amendment filed 9-21-84; effective thirtieth day thereafter (Register 84, No. 38).
8. Editorial correction of Form Reference (Register 91, No. 24).
9. New subsections (e)-(e)(5) filed 7-3-2003 as an emergency; operative 7-4-2003 (Register 2003, No. 27). A Certificate of Compliance must be transmitted to OAL by 11-3-2003 or emergency language will be repealed by operation of law on the following day.
10. New subsections (e)-(e)(5) refiled 10-31-2003 as an emergency; operative 11-3-2003 (Register 2003, No. 44). A Certificate of Compliance must be transmitted to OAL by 3-2-2004 or emergency language will be repealed by operation of law on the following day.
11. Amendment of section and Note filed 1-16-2004 as an emergency; operative 1-16-2004 (Register 2004, No. 3). A Certificate of Compliance must be transmitted to OAL by 5-17-2004 or emergency language will be repealed by operation of law on the following day.
12. Certificate of Compliance as to 10-31-2003 order, including amendment of subsection (e) and new subsection (e)(6), transmitted to OAL 3-2-2004 and filed 4-13-2004 (Register 2004, No. 16).
13. Amendment of section and Note refiled 5-17-2004 as an emergency; operative 5-17-2004 (Register 2004, No. 21). A Certificate of Compliance must be transmitted to OAL by 9-14-2004 or emergency language will be repealed by operation of law on the following day.
14. Certificate of Compliance as to 5-17-2004 order, including further amendment of section and Note, transmitted to OAL 9-14-2004 and filed 10-27-2004 (Register 2004, No. 44).
15. Amendment of subsections (a)(2) and (c)-(e), new subsection (f) and new Note filed 6-22-2005; operative 7-22-2005 (Register 2005, No. 25).
16. Amendment of subsections (a)(2), (c) and (d) filed 9-24-2009; operative 10-24-2009 (Register 2009, No. 39).
17. Change without regulatory effect amending subsections (a)(2), (c) and (d) filed 8-13-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 33).
2. Certificate of Compliance including amendment transmitted to OAL 2-22-82 and filed 3-24-82 (Register 82, No. 13).
3. Amendment of subsection (a)(1) filed 10-15-82; effective thirtieth day thereafter (Register 82, No. 42).
4. Editorial correction of subsection (d) to correct printing error (Register 83, No. 11).
5. Amendment filed 9-30-83 as an emergency; effective upon filing (Register 83, No. 40). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 1-28-84.
6. Certificate of Compliance including amendment as to 9-30-83 order transmitted to OAL 1-25-84 and filed 2-16-84 (Register 84, No. 7).
7. Amendment filed 9-21-84; effective thirtieth day thereafter (Register 84, No. 38).
8. Editorial correction of Form Reference (Register 91, No. 24).
9. New subsections (e)-(e)(5) filed 7-3-2003 as an emergency; operative 7-4-2003 (Register 2003, No. 27). A Certificate of Compliance must be transmitted to OAL by 11-3-2003 or emergency language will be repealed by operation of law on the following day.
10. New subsections (e)-(e)(5) refiled 10-31-2003 as an emergency; operative 11-3-2003 (Register 2003, No. 44). A Certificate of Compliance must be transmitted to OAL by 3-2-2004 or emergency language will be repealed by operation of law on the following day.
11. Amendment of section and Note filed 1-16-2004 as an emergency; operative 1-16-2004 (Register 2004, No. 3). A Certificate of Compliance must be transmitted to OAL by 5-17-2004 or emergency language will be repealed by operation of law on the following day.
12. Certificate of Compliance as to 10-31-2003 order, including amendment of subsection (e) and new subsection (e)(6), transmitted to OAL 3-2-2004 and filed 4-13-2004 (Register 2004, No. 16).
13. Amendment of section and Note refiled 5-17-2004 as an emergency; operative 5-17-2004 (Register 2004, No. 21). A Certificate of Compliance must be transmitted to OAL by 9-14-2004 or emergency language will be repealed by operation of law on the following day.
14. Certificate of Compliance as to 5-17-2004 order, including further amendment of section and Note, transmitted to OAL 9-14-2004 and filed 10-27-2004 (Register 2004, No. 44).
15. Amendment of subsections (a)(2) and (c)-(e), new subsection (f) and new Note filed 6-22-2005; operative 7-22-2005 (Register 2005, No. 25).
16. Amendment of subsections (a)(2), (c) and (d) filed 9-24-2009; operative 10-24-2009 (Register 2009, No. 39).
17. Change without regulatory effect amending subsections (a)(2), (c) and (d) filed 8-13-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 33).