Form IN-1461 "Notice of Sale of Securities Pursuant to Employee Stock Purchase/Option Plan Exemption" - Tennessee

What Is Form IN-1461?

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

Form Details:

  • The latest edition provided by the Tennessee Department of Commerce and Insurance;
  • 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 printable version of Form IN-1461 by clicking the link below or browse more documents and templates provided by the Tennessee Department of Commerce and Insurance.

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Download Form IN-1461 "Notice of Sale of Securities Pursuant to Employee Stock Purchase/Option Plan Exemption" - Tennessee

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Tennessee Department of Commerce and Insurance
Division of Securities
NOTICE OF SALE OF SECURITIES PURSUANT TO
EMPLOYEE STOCK PURCHASE/OPTION PLAN EXEMPTION
1. Issuer:
Name:
Address:
Phone Number:
2. Form of Organization (Check One):
Corporation
Unincorporated Association
Limited Liability Company
Limited Partnership
Other (Specify):
Issuer’s state of Incorporation or jurisdiction or organization:
Date of Incorporation or Organization:
3. Officers and Directors (or persons acting in a similar capacity):
Name, Address, and Phone Number
Capacity
(attach additional sheets if necessary)
Page 1 of 3
Tennessee Department of Commerce and Insurance
Division of Securities
NOTICE OF SALE OF SECURITIES PURSUANT TO
EMPLOYEE STOCK PURCHASE/OPTION PLAN EXEMPTION
1. Issuer:
Name:
Address:
Phone Number:
2. Form of Organization (Check One):
Corporation
Unincorporated Association
Limited Liability Company
Limited Partnership
Other (Specify):
Issuer’s state of Incorporation or jurisdiction or organization:
Date of Incorporation or Organization:
3. Officers and Directors (or persons acting in a similar capacity):
Name, Address, and Phone Number
Capacity
(attach additional sheets if necessary)
Page 1 of 3
4. This Offering:
Description of
Price per
Number of Securities
Aggregate Dollar
Security
Security
to be Offered
Amount
Debt
Equity (common
or preferred)
Convertible
Security
Partnership
Interests
Other (Specify)
5. Description of Business:
6. Submitted herewith as part of this notice are the following:
(a)
Consent to service of process.
(b)
Non-refundable filing fee of five hundred dollars ($500).
Page 2 of 3
Execution and Certification
By filing this Notice of Transaction, the Issuer of these securities hereby represents that:
The undersigned represents that the Issuer is familiar with the conditions that must be
satisfied to be entitled to the Employer Stock Option/Purchase Plan 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.
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
Name (Print or Type)
Title (Print or Type)
Date
IN-1461
RDA 959
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