Cal. Code Regs. tit. 10 § 260.146
Any issuer selling securities pursuant to an open qualification, so long as it is not exempt from this requirement by Section 25146 of the Code and is not filing reports pursuant to Section 13 (15 USC 78m) or Section 15(d) (15 USC 78o(d)) of the Securities Exchange Act of 1934 (15 USC 78a et seq.), shall file semi-annual reports with the Commissioner within 120 days after the end of its fiscal year and within 90 days after the end of the first six months of its fiscal year. Such reports shall be filed until the expiration of 18 months after the qualification was effective or until the securities which were the subject of the application have been qualified for trading in this State under Section 25131 of the Code, whichever first occurs. Such report shall be made on the following form:
DEPARTMENT OF BUSINESS OVERSIGHT
FILE NO. ______________________________
(Insert file number of qualification to which report relates.)
Date of Report:________________________________________
DEPARTMENT OF BUSINESS OVERSIGHT STATE OF CALIFORNIA
SEMI-ANNUAL REPORT PURSUANT TO SECTION 25146 OF THE CORPORATE SECURITIES LAW OF 1968
___________________________
| Number and Street | City | State | Zip Code |
___________________________
___________________________
Financial Statements. (There should be attached to a report filed as of the end of a fiscal year a balance sheet as of that date and a profit and loss statement for the year then ended, covered by an auditor's report containing an unqualified opinion of an independent certified public accountant or an independent public accountant. There should be attached to a report filed as of the end of the first six months of a fiscal year a balance sheet as of that date and a profit and loss statement for the six-months' period then ended; such statements need not be audited but shall be prepared in accordance with generally accepted accounting principles.)
______________________________
(Issuer)
By____________________________
(Title)
I certify (or declare) under penalty of perjury under the laws of the State of California that I have read this report and the exhibits thereto and know the contents thereof, and that the statements therein are true and correct.
Executed at__________(Place), on __________(Date), 20___.
______________________________
(Signature)
Instructions: The report should be signed by an officer or general partner of the issuer; however, it may be signed by another person holding a power of attorney for such purposes from the issuer and, if signed on behalf of the issuer pursuant to such power of attorney, should include as an additional exhibit a copy of said power of attorney or a copy of the corporate resolution authorizing the person to sign on behalf of the corporation.
Cal. Code Regs. Tit. 10, § 260.146
2. Amendment filed 6-12-80; effective thirtieth day thereafter (Register 80, No. 24).
3. Amendment filed 2-11-85; effective thirtieth day thereafter (Register 85, No. 7).
4. Amendment filed 1-10-89; operative 2-9-89 (Register 89, No. 2).
5. Change without regulatory effect amending certification filed 9-25-2002 pursuant to section 100, title 1, California Code of Regulations (Register 2002, No. 39).
6. Change without regulatory effect amending form headings filed 8-13-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 33).
Note: Authority cited: Sections 25146 and 25610, Corporations Code. Reference: Section 25146, Corporations Code.
2. Amendment filed 6-12-80; effective thirtieth day thereafter (Register 80, No. 24).
3. Amendment filed 2-11-85; effective thirtieth day thereafter (Register 85, No. 7).
4. Amendment filed 1-10-89; operative 2-9-89 (Register 89, No. 2).
5. Change without regulatory effect amending certification filed 9-25-2002 pursuant to section 100, title 1, California Code of Regulations (Register 2002, No. 39).
6. Change without regulatory effect amending form headings filed 8-13-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 33).