California Code of Regulations › Title 10 - Investment › Chapter 3 - Commissioner of Financial Protection and Innovation › Subchapter 2 - Corporate Securities › Article 2 - Exemptions from Qualification › Section 260.103.6 - Limited Exchange Transaction-Notice of Exchange Transaction

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An acquiring or
				  converting entity in an exchange under Section
				  25103(h) of the
				  Code shall file a Notice of Exchange Transaction with the Commissioner no later
				  than 15 calendar days after the first sale of the securities in the transaction
				  in this state. No notice is required to be filed if there is no sale in this
				  state.
(b) The notice referred to
				  in subdivision (h) of Section
				  25103 of the Code shall be in the
				  following form:
(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: $600
(See Corporations Code Section
					 25608(z))
COMMISSIONER OF BUSINESS OVERSIGHT STATE OF
					 CALIFORNIA
NOTICE OF EXCHANGE TRANSACTION OR ENTITY CONVERSION
					 PURSUANT TO CORPORATIONS CODE SECTION
					 25103(h)
1. Name of acquiring or
				  converting entity (entity resulting from the conversion):
				  ___________________________
___________________________
2.
(a)
				  Address of acquiring or converting entity:
______________________________________________________
Street
City
State
ZIP
(b) Mailing address:
______________________________________________________
Street
City
State
ZIP
___________________________
(c) Area code and telephone
				  number:
3. Acquiring or
				  converting entity's state or other jurisdiction of incorporation or
				  organization:
___________________________
___________________________
4.
(a) Name
				  of entity to be acquired or converted:
___________________________
(b) State or jurisdiction of incorporation or
				  organization of entity to be acquired or converted:
___________________________
5. The exchange of securities meets the
				  requirements of (check one):
( ) Section
					 25103(h)(1)(A) of
					 the Code.
___________________________
( ) Section
					 25103(h)(1)(B) of
					 the Code, and the state of incorporation or organization is
____________________
, or the form of the organization is
.
6.
				  Type of filing under the Securities Act of 1933, if applicable:
___________________________
___________________________
7. Date of Notice:
____________________
( )
Check if acquiring or
							 converting
Acquiring or converting entity
entity has a consent to service
							 of
___________________________
process on file with the
Commissioner
Authorized signature
							 on behalf of acquiring or converting entity
___________________________
Print Name and Title of
							 Signatory
Name, Address and Phone Number of Contact Person:
___________________________
___________________________
___________________________
___________________________
Instructions: Each acquiring or converting entity (other
					 than a California corporation) filing a notice under Section
					 25103(h) must
					 file a consent to service of process (Form 260.165), unless it already has a
					 consent to service on file with the Commissioner.
260.103.6 (9/09)