Section 56 Form U-1-Uniform Application to Register Securities

• Library: Business Transitions 2009 Forms

The following form is available on the internet at the Missouri Secretary of State's website at:

www.sos.mo.gov/securities/registration2.asp

Form U-1

Uniform Application to Register Securities

Application to............................................................ of the State of......................................................

pursuant to Section............................................... of the........................................................................

1. Name and address of issuer and principal office in this state:

2. Name, address and telephone number of correspondent to whom notices and communications regarding this application may be sent:

3. Name and address of applicant:

4. Registration or acceptance for filing is sought for the following described securities in the amounts indicated:

+----------------+----------------+----------------+---------------+-------------------------+
                | | | Total Offering | | Offering in this State |
                +----------------+----------------+----------------+---------------+-------------------------+
                | Description of | Offering Price | No. of Shares | No. of Shares | or Units Amount  |
                | Securities | or Proposed | or Units | Amount  | |
                | | Offering Price | | | |
                +----------------+----------------+----------------+---------------+-------------------------+
                | | | | $  | $  |
                +----------------+----------------+----------------+---------------+-------------------------+
                | | | | | |
                +----------------+----------------+----------------+---------------+-------------------------+
                | | | Totals | $  | $  |

...