Form Nyf-6 - Application Exemption Form - New York Department Of Law
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1STATE OF NEW YORK
NYF-6
DEPARTMENT OF LAW
1-81
BUREAU OF INVESTOR PROTECTION AND SECURITIES
APPLICATION EXEMPTION FORM
_________________________
_____________________
Franchisor
Street Address
_________________________
_____________________
City, State
Zip Code
Telephone Number
______________________________________ hereby submits certified
copies of its most recent audited balance sheet and profit and loss
statement, attached hereto and mark as Exhibit A, and hereby certifies
that.
1.
The franchisor, according to the statement submitted, has
a net worth of not less than five millon dollars or if
its net worth is less than 5 million dollars and more than
one million dollars, the franchisor is 80% owned by
____________________________________ which has
a net worth, on a consolidated basis, of not less than
five million dollars as reflected by its most recent
audited balance sheet and profit and loss statement,
which is attached hereto and marked as Exhibit B.
2.
The identity and business experience in the detail
required by Section 200.4 subdivision (iii), paragraphs
2 through 4 of these regulations of persons affiliated
with the franchisor is as follows: (attach rider)
3.
The franchisor will comply with the provisions of
Section 684.2 (c) of the General Business Law.
4.
Annexed hereto as Exhibit is a Consent to Service
of Process (NYF-5).
5.
This application is made for an exemption pursuant to
Section 684.2 of the General Business Law.
________________________________
Signature of Franchisor
(SEAL)
By_______________________________
_________________________________
Title
Sworn to before me this
day of
, 20
____________________________
NOTARY PUBLIC
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