Cal. Code Regs. Tit. 10, § 260.507 - Form of Application for Approval of Repurchase Offer Facing Page
An application for approval as to form of an offer to repurchase a security in accordance with Subdivision (b) of Section 25507 of the Code shall have as the first page thereof a facing page in the following form containing the information therein specified:
(Department of Business Oversight Use Only)
Fee Paid $___________________________ | |||
Receipt No.___________________________ | DEPARTMENT OF BUSINESS OVERSIGHT | ||
File No.___________________________ | |||
(Insert file number of previous filings of applicant before the Department, if any) | |||
FEE:___________________________ | |||
(To be completed by applicant) | |||
Date of application:___________________________ |
DEPARTMENT OF BUSINESS OVERSIGHT STATE OF CALIFORNIA FACING PAGE
APPLICATION FOR APPROVAL AS TO FORM OF AN OFFER TO REPURCHASE A SECURITY UNDER SUBDIVISION (b) OF SECTION 25507 OF THE CORPORATE SECURITIES LAW OF 1968.
Number and Street | City | State | Zip Code |
6. | (a) | (b) | (c) | (d) |
Type of security | Number of shares or units covered by the offer. | Aggregate value of consideration received. | If a cash offer aggregate amount to be offered. | |
___________________________ | ___________________________ | |||
___________________________ | ___________________________ | |||
___________________________ | ___________________________ | $___________________________ | $___________________________ |
INSTRUCTIONS
Completion of Application. The application should be continued in typewritten or printed form in the English language, on one side only of either legal or letter size paper which should be attached to the facing page when submitted. Provide the information required by Items 7 through 9 below. Identify each statement by reference to the item number. Any item which is inapplicable should be listed by the number of the item, followed simply by the word "inapplicable." At each item where relevant refer to and incorporate by reference any attached exhibits or documents and any documents currently on file with the Department. Such reference should indicate the page or portion of the document where the information is located. Sign and verify the last page in the manner shown in the instructions below.
"THIS OFFER OF REPURCHASE HAS BEEN APPROVED BY THE COMMISSIONER OF CORPORATIONS IN ACCORDANCE WITH SECTION 25507(b) OF THE CORPORATE SECURITIES LAW OF 1968 ONLY AS TO ITS FORM. SUCH APPROVAL DOES NOT IMPLY A FINDING BY THE COMMISSIONER THAT ANY STATEMENTS MADE HEREIN OR IN ANY ACCOMPANYING DOCUMENTS ARE TRUE OR COMPLETE; NOR DOES IT IMPLY A FINDING THAT THE AMOUNT OFFERED BY THE SELLER IS EQUAL TO THE AMOUNT RECOVERABLE BY THE BUYER OF THE SECURITY IN ACCORDANCE WITH SECTION 25503 IN A SUIT AGAINST THE SELLER, AND THE COMMISSIONER DOES NOT ENDORSE THE OFFER AND MAKES NO RECOMMENDATION AS TO ITS ACCEPTANCE OR REJECTION."
(NOTE: The application must be signed and verified in the following manner.)
The applicant has duly caused this application to be signed on its behalf by the undersigned, thereunto duly authorized.
__________
(Applicant)
By__________
__________
(Title)
I certify (or declare) under penalty of perjury under the laws of the State of California that I have read this application 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)
Signing of Application. Application should be signed by an officer or general partner of the applicant; however, it may be signed by another person holding a power of attorney for such purposes from the applicant, and if signed on behalf of the applicant 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 attorney to act.
Incorporation by Reference. In lieu of answering any specific item in this form, an applicant may incorporate the information called for by reference to any attached document, or to any document currently on file with the Department. Such reference should indicate the pages or portion of the document where the information is located.
Filing Fee. The filing fee shall be the amount that would have been payable under subdivisions (e), (f), (h) or (i) of Section 25608 if an application had been filed to qualify the transaction in which the securities were sold in violation of the qualification provisions. The filing fee fixed by Section 25608 must accompany each application and the amount of filing fee paid is to be set forth on the front page in the upper right hand corner.
By way of illustration, the filing fee for qualification of securities by coordination, notification, or permit, under Sections 25113 or 25121 is computed by taking 2/10 ths of 1% of the maximum aggregate offering price of securities being qualified in California and adding $200. Thus, a qualification, for $275,250 would be computed by moving the decimal point three places to the left, $275.25, doubling the amount, $550.50, and adding $200 for a total of $750.00.
Notes
2. Amendment refiled 1-7-77; effective thirtieth day thereafter (Register 77, No. 2).
3. Redesignation of Sections 260.507-260.617, not consecutive, from Article 13 to Subarticle 2 of Article 13 filed 1-10-79; effective thirtieth day thereafter (Register 79, No. 2).
4. Amendment filed 6-12-80; effective thirtieth day thereafter (Register 80, No. 24).
5. Editorial correction of NOTE filed 3-9-83 (Register 83, No. 11).
6. Change without regulatory effect (Register 87, No. 29).
7. Change without regulatory effect amending certification and last paragraph filed 9-25-2002 pursuant to section 100, title 1, California Code of Regulations (Register 2002, No. 39).
8. Change without regulatory effect amending form filed 8-13-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 33).
Note: Authority cited: Sections 25507(b) and 25610, Corporations Code. Reference: Sections 25500, 25501, 25502, 25503, 25504, 25504.1 and 25507, Corporations Code.
2. Amendment refiled 1-7-77; effective thirtieth day thereafter (Register 77, No. 2).
3. Redesignation of Sections 260.507-260.617, not consecutive, from Article 13 to Subarticle 2 of Article 13 filed 1-10-79; effective thirtieth day thereafter (Register 79, No. 2).
4. Amendment filed 6-12-80; effective thirtieth day thereafter (Register 80, No. 24).
5. Editorial correction of NOTE filed 3-9-83 (Register 83, No. 11).
6. Change without regulatory effect (Register 87, No. 29).
7. Change without regulatory effect amending certification and last paragraph filed 9-25-2002 pursuant to section 100, title 1, California Code of Regulations (Register 2002, No. 39).
2. Amendment refiled 1-7-77; effective thirtieth day thereafter (Register 77, No. 2).
3. Redesignation of Sections 260.507-260.617, not consecutive, from Article 13 to Subarticle 2 of Article 13 filed 1-10-79; effective thirtieth day thereafter (Register 79, No. 2).
4. Amendment filed 6-12-80; effective thirtieth day thereafter (Register 80, No. 24).
5. Editorial correction of NOTE filed 3-9-83 (Register 83, No. 11).
6. Change without regulatory effect (Register 87, No. 29).
7. Change without regulatory effect amending certification and last paragraph filed 9-25-2002 pursuant to section 100, title 1, California Code of Regulations (Register 2002, No. 39).
8. Change without regulatory effect amending form filed 8-13-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 33).
2. Amendment refiled 1-7-77; effective thirtieth day thereafter (Register 77, No. 2).
3. Redesignation of Sections 260.507-260.617, not consecutive, from Article 13 to Subarticle 2 of Article 13 filed 1-10-79; effective thirtieth day thereafter (Register 79, No. 2).
4. Amendment filed 6-12-80; effective thirtieth day thereafter (Register 80, No. 24).
5. Editorial correction of NOTE filed 3-9-83 (Register 83, No. 11).
6. Change without regulatory effect (Register 87, No. 29).
7. Change without regulatory effect amending certification and last paragraph filed 9-25-2002 pursuant to section 100, title 1, California Code of Regulations (Register 2002, No. 39).
8. Change without regulatory effect amending form filed 8-13-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 33).
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