Form DFPI-260.102.19 "Notice of Issuance of Securities Pursuant to Subdivision (O) of Section 25102 of the Corporations Code" - California

What Is Form DFPI-260.102.19?

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 November 1, 2020;
  • 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 DFPI-260.102.19 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 DFPI-260.102.19 "Notice of Issuance of Securities Pursuant to Subdivision (O) of Section 25102 of the Corporations Code" - California

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STATE OF CALIFORNIA – DEPARTMENT OF FINANCIAL PROTECTION AND INNOVATION
NOTICE OF ISSUANCE OF SECURITIES PURSUANT TO SUBDIVISION (o) OF
DFPI–260.102.19 (Register 2002, No. 39) (Rev. 11-20)
SECTION 25102 OF THE CORPORATIONS CODE
(Department of Financial Protection and
DEPARTMENT OF FINANCIAL
Innovation Use Only)
PROTECTION AND INNOVATION
Fee Paid $ ___________________
NOTICE ID:
______________________________
☐ Check if Increase in Dollar Amount
(Insert Notice ID of Previous
Note: Report only the amount of increase
Filings Before the Department, If Any)
FEE: $______________
(See Corporations Code Section 25608(y) and Section 25608(e).
The fee is based on the current market value of the securities, or in the case of options, the underlying
securities.)
1. Name of Issuer:
2. State of Incorporation or Organization: __________________________________________________
3. Address of Principal Place of Business:
_________________________________________________________________________________
Number and Street
City
State
Zip Code
4. The security is issued pursuant to a: (Check One)
Purchase Plan or Agreement
Name of Security: ________________________________________________________________
Number of Securities: _____________________________________________________________
Price Per Security: $______________________________________________________________
Option Plan or Agreement.
Name and Number of Options: ______________________________________________________
Name and Number of the Underlying Securities:
_______________________________________________________________________________
Exercise Price Per Security: $_______________________________________________________
"Flexible" Purchase/Option Plan or Agreement.
Name of Security/Option: __________________________________________________________
Number of Securities/Options: _____________________________________________________
Name and Number of the Underlying Securities: ________________________________________
Price Per Security: $______________________________________________________________
5.
Aggregate current market value of securities sought to be sold in California:___________________
6.
Date of First Sale: ________________________________________________________________
Check if Issuer has
a consent to service of process
____________________________________
on file with the Commissioner
Name of Issuer
____________________________________
Authorized Signature on Behalf of Issuer
____________________________________
Print Name and Title of Signatory
Name, Address and Phone Number of Contact Person:
Instructions: Each issuer (other than a California corporation) filing a notice under Section 25102(o) must
file a consent to service of process (Form 260.165), unless it already has a consent to service on file with
the Commissioner.
STATE OF CALIFORNIA – DEPARTMENT OF FINANCIAL PROTECTION AND INNOVATION
NOTICE OF ISSUANCE OF SECURITIES PURSUANT TO SUBDIVISION (o) OF
DFPI–260.102.19 (Register 2002, No. 39) (Rev. 11-20)
SECTION 25102 OF THE CORPORATIONS CODE
(Department of Financial Protection and
DEPARTMENT OF FINANCIAL
Innovation Use Only)
PROTECTION AND INNOVATION
Fee Paid $ ___________________
NOTICE ID:
______________________________
☐ Check if Increase in Dollar Amount
(Insert Notice ID of Previous
Note: Report only the amount of increase
Filings Before the Department, If Any)
FEE: $______________
(See Corporations Code Section 25608(y) and Section 25608(e).
The fee is based on the current market value of the securities, or in the case of options, the underlying
securities.)
1. Name of Issuer:
2. State of Incorporation or Organization: __________________________________________________
3. Address of Principal Place of Business:
_________________________________________________________________________________
Number and Street
City
State
Zip Code
4. The security is issued pursuant to a: (Check One)
Purchase Plan or Agreement
Name of Security: ________________________________________________________________
Number of Securities: _____________________________________________________________
Price Per Security: $______________________________________________________________
Option Plan or Agreement.
Name and Number of Options: ______________________________________________________
Name and Number of the Underlying Securities:
_______________________________________________________________________________
Exercise Price Per Security: $_______________________________________________________
"Flexible" Purchase/Option Plan or Agreement.
Name of Security/Option: __________________________________________________________
Number of Securities/Options: _____________________________________________________
Name and Number of the Underlying Securities: ________________________________________
Price Per Security: $______________________________________________________________
5.
Aggregate current market value of securities sought to be sold in California:___________________
6.
Date of First Sale: ________________________________________________________________
Check if Issuer has
a consent to service of process
____________________________________
on file with the Commissioner
Name of Issuer
____________________________________
Authorized Signature on Behalf of Issuer
____________________________________
Print Name and Title of Signatory
Name, Address and Phone Number of Contact Person:
Instructions: Each issuer (other than a California corporation) filing a notice under Section 25102(o) must
file a consent to service of process (Form 260.165), unless it already has a consent to service on file with
the Commissioner.