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Manual Exemption Annual Certification Form
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Description
Maine Office of Securities Manual Exemption Annual Certification Form By my notarized signature, I certify on behalf of , the company that produces the securities manual or its electronic equivalent listed below, that: 1. I am an officer of the named company; 2. I have knowledge of the information contained in the following securities manual or its electronic equivalent produced by the named company: ; and 3. To the best of my knowledge and belief, the above-mentioned manual or its electronic equivalent contains for each listed issuer the information required by 32 M.R.S.A. 247 16202(2)(D)(1) (4). Name: Signature: Date: Title: Company: ******************* State of County of The foregoing instrument was acknowledged before me this day of , 20, by , of (name) (title) , a corporation, on (name of corporation acknowledging) (state/ place of incorporation) behalf of the corporation. Signature of Notary Public Name of Notary Public (printed): SEAL Notary Public, State of My commission expires: American LegalNet, Inc. www.FormsWorkFlow.com
