Form SFN52009 "Accredited Investor Exemption" - North Dakota

What Is Form SFN52009?

This is a legal form that was released by the North Dakota Securities Department - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2013;
  • The latest edition provided by the North Dakota Securities Department;
  • 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 SFN52009 by clicking the link below or browse more documents and templates provided by the North Dakota Securities Department.

ADVERTISEMENT
ADVERTISEMENT

Download Form SFN52009 "Accredited Investor Exemption" - North Dakota

646 times
Rate (4.5 / 5) 32 votes
FORM AIE
ACCREDITED INVESTOR EXEMPTION
Securities Department
NORTH DAKOTA SECURITIES DEPARTMENT
600 E Boulevard Ave Dept 414
SFN 52009 (10-2013)
Bismarck ND 58505
(701) 328-2910
www.nd.gov/securities
UNIFORM NOTICE OF TRANSACTION
NOTICE OF SALE OF SECURITIES PURSUANT TO ACCREDITED
INVESTOR EXEMPTION, SECTION 10-04-06, N.D.C.C.
1. ISSUER:
Name:
Telephone Number:
Address:
City:
State:
ZIP Code:
2. FORM OF ORGANIZATION (Check One)
Corporation
Unincorporated Association
Limited Liability Company
Limited Partnership
Other (Specify)
3. OFFICERS AND DIRECTORS (or persons acting in a similar capacity)
4. THIS OFFERING:
Price per Security
Number of Securities to be Offered
Aggregate Dollar Amount
Description of Security
Debt (Specify)
Common Stock
Preferred Stock
Convertible Security
Partnership Interests
Limited Liability Interests
Other (Specify)
5. DESCRIPTION OF BUSINESS:
FORM AIE
ACCREDITED INVESTOR EXEMPTION
Securities Department
NORTH DAKOTA SECURITIES DEPARTMENT
600 E Boulevard Ave Dept 414
SFN 52009 (10-2013)
Bismarck ND 58505
(701) 328-2910
www.nd.gov/securities
UNIFORM NOTICE OF TRANSACTION
NOTICE OF SALE OF SECURITIES PURSUANT TO ACCREDITED
INVESTOR EXEMPTION, SECTION 10-04-06, N.D.C.C.
1. ISSUER:
Name:
Telephone Number:
Address:
City:
State:
ZIP Code:
2. FORM OF ORGANIZATION (Check One)
Corporation
Unincorporated Association
Limited Liability Company
Limited Partnership
Other (Specify)
3. OFFICERS AND DIRECTORS (or persons acting in a similar capacity)
4. THIS OFFERING:
Price per Security
Number of Securities to be Offered
Aggregate Dollar Amount
Description of Security
Debt (Specify)
Common Stock
Preferred Stock
Convertible Security
Partnership Interests
Limited Liability Interests
Other (Specify)
5. DESCRIPTION OF BUSINESS:
SFN 52009 (10-2013)
Page 2 of 2
6. NAME OF BROKER-DEALER who has solicited or intends to solicit purchasers in this state:
BUSINESS ADDRESS:
By filing this Notice of Transaction, the Issuer of these securities hereby represents that:
(1) Sales of securities shall be made only to accredited investors as defined in 17 CFR 230.501(a).
(2) The issuer is not an issuer in the development stage that either has no specific business plan
or purpose or has indicated that its business plan is to engage in a merger or acquisition with
an unidentified company or companies, or other entity or person.
(3) The Issuer reasonably believes that all purchasers are purchasing for investment and not with
the view to or for sale in connection with a distribution of the security. Any resale of a
security sold in reliance on this exemption within 12 months of sale, except a resale to an
accredited investor or pursuant to a registration statement effective under applicable state
securities law, shall be presumed to be with a view to distribution and not for investment.
Securities issued under this exemption may only be resold pursuant to registration or an
exemption under applicable state securities law.
The undersigned represents that the Issuer is familiar with the conditions that must be satisfied to be
entitled to the Accredited Investor Exemption of the state in which this notice is filed and understands that
the Issuer claiming the availability of this exemption has the burden of establishing that these conditions
have been satisfied.
Include with the notice form a Consent to Service of Process (Form U-2); the general announcement, if
applicable; and a filing fee of $100.
The issuer has read this notification and knows the contents to be true and has duly caused this notice to
be signed on its behalf by the undersigned duly authorized person.
Issuer: (Print or Type)
Signature:
Date:
Name: (Print or Type)
Title: (Print or Type)
Page of 2