Form DBO-260.103.6(B) "Notice of Exchange Transaction or Entity Conversion Pursuant to Corporations Code Section 25103(H)" - California

What Is Form DBO-260.103.6(B)?

This is a legal form that was released by the California Department of Financial Protection and Innovation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2017;
  • The latest edition provided by the California Department of Financial Protection and Innovation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DBO-260.103.6(B) by clicking the link below or browse more documents and templates provided by the California Department of Financial Protection and Innovation.

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Download Form DBO-260.103.6(B) "Notice of Exchange Transaction or Entity Conversion Pursuant to Corporations Code Section 25103(H)" - California

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STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT
NOTICE OF EXCHANGE TRANSACTION OR ENTITY CONVERSION
PURSUANT TO CORPORATIONS CODE SECTION 25103(h)
DBO–260.103.6(b) (Register 2009, No. 39) (Rev. 10-17)
(Department of Business Oversight Use Only)
Department of Business Oversight File No., if any
Fee Paid $ ____________________________
_____________________________________
Receipt No. ___________________________
(Insert File Numbers(s) of Previous Filings
Before the Department, if any)
FEE: $600
(See Corporations Code Section 25608(z))
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
State
Zip
City
(c) Area code and telephone number: ___________________________________________
3.
Acquiring or converting entity's state or 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 organization is ______________________________
STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT
NOTICE OF EXCHANGE TRANSACTION OR ENTITY CONVERSION
PURSUANT TO CORPORATIONS CODE SECTION 25103(h)
DBO–260.103.6(b) (Register 2009, No. 39) (Rev. 10-17)
(Department of Business Oversight Use Only)
Department of Business Oversight File No., if any
Fee Paid $ ____________________________
_____________________________________
Receipt No. ___________________________
(Insert File Numbers(s) of Previous Filings
Before the Department, if any)
FEE: $600
(See Corporations Code Section 25608(z))
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
State
Zip
City
(c) Area code and telephone number: ___________________________________________
3.
Acquiring or converting entity's state or 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 organization is ______________________________
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
NOTICE OF EXCHANGE TRANSACTION OR ENTITY CONVERSION
PURSUANT TO CORPORATIONS CODE SECTION 25103(h)
DBO–260.103.6(b) (Register 2009, No. 39) (Rev. 10-17) Page 2 of 2
6.
Type of filing under the Securities Act of 1933, if applicable:
___________________________________________________________________________
7.
Date of Notice:__________
__________________________________________________
Acquiring or converting entity
Check converting 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.
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