Form ABC-815 "Private Equity Fund Affidavit" - California

What Is Form ABC-815?

This is a legal form that was released by the California Department of Alcoholic Beverage Control - 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 January 1, 2016;
  • The latest edition provided by the California Department of Alcoholic Beverage Control;
  • 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 ABC-815 by clicking the link below or browse more documents and templates provided by the California Department of Alcoholic Beverage Control.

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Download Form ABC-815 "Private Equity Fund Affidavit" - California

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Department of Alcoholic Beverage Control
State of California
PRIVATE EQUITY FUND AFFIDAVIT
Gavin Newsom , Governor
I,
________________________
am the
_____________________
of the below-named private
(NAME)
(POSITION)
equity fund; am authorized to execute this affidavit and hereby declare:
1.
The below-named private equity fund is an investment company that makes
investments in equity or debt securities of another company that does not provide
investors with redemption rights in the ordinary course. This entity is not a hedge fund,
real estate fund, securitized asset fund, or venture capital fund.
2.
The private equity fund's interest in the license is limited to a passive investment, so that
neither the private equity fund nor any manager, employee, or agent of the private
equity fund has any involvement in, or control over, the management of the licensed
business or of the licensee.
3.
The private equity fund advisors are registered under the federal Investment Advisors
Act of 1940, and the private equity fund advisors are subject to, and comply with,
Section 275.204(b)-1 of Title 17 of the Code of Federal Regulations.
4.
No investor in the private equity fund holds, directly or indirectly, more than 10-percent
interest in the private equity fund.
5.
No investor in the private equity fund has any control, directly or indirectly, over the
investment decisions of the private equity fund.
6.
No person, by reason of his or her investment in a private equity fund, holds an interest
in a license issued by the Department if that interest is not otherwise permitted.
If I do not have personal knowledge of any of the facts necessary to execute the affidavit, I
have made a diligent inquiry and execute this affidavit upon information and belief.
I, or any subsequent manager or authorized agent of the private equity fund, shall promptly
notify the Department in writing if any of the facts attested change.
NAME OF LICENSE APPLICANT / FILE NUMBER
NAME OF PRIVATE EQUITY FUND
AFFIANT PRINTED NAME
AFFIANT POSITION
AFFIANT SIGNATURE
DATE SIGNED
ABC-815 (rev. 01/16)
Department of Alcoholic Beverage Control
State of California
PRIVATE EQUITY FUND AFFIDAVIT
Gavin Newsom , Governor
I,
________________________
am the
_____________________
of the below-named private
(NAME)
(POSITION)
equity fund; am authorized to execute this affidavit and hereby declare:
1.
The below-named private equity fund is an investment company that makes
investments in equity or debt securities of another company that does not provide
investors with redemption rights in the ordinary course. This entity is not a hedge fund,
real estate fund, securitized asset fund, or venture capital fund.
2.
The private equity fund's interest in the license is limited to a passive investment, so that
neither the private equity fund nor any manager, employee, or agent of the private
equity fund has any involvement in, or control over, the management of the licensed
business or of the licensee.
3.
The private equity fund advisors are registered under the federal Investment Advisors
Act of 1940, and the private equity fund advisors are subject to, and comply with,
Section 275.204(b)-1 of Title 17 of the Code of Federal Regulations.
4.
No investor in the private equity fund holds, directly or indirectly, more than 10-percent
interest in the private equity fund.
5.
No investor in the private equity fund has any control, directly or indirectly, over the
investment decisions of the private equity fund.
6.
No person, by reason of his or her investment in a private equity fund, holds an interest
in a license issued by the Department if that interest is not otherwise permitted.
If I do not have personal knowledge of any of the facts necessary to execute the affidavit, I
have made a diligent inquiry and execute this affidavit upon information and belief.
I, or any subsequent manager or authorized agent of the private equity fund, shall promptly
notify the Department in writing if any of the facts attested change.
NAME OF LICENSE APPLICANT / FILE NUMBER
NAME OF PRIVATE EQUITY FUND
AFFIANT PRINTED NAME
AFFIANT POSITION
AFFIANT SIGNATURE
DATE SIGNED
ABC-815 (rev. 01/16)