Form of Ownership. Check the appropriate box (one only) to indicate form of ownership. If the subscriber is a Custodian, Corporation, Partnership or Trust, please provide the additional information requested. o Individual o Joint Tenants with Right of Survivorship (Both signatures must appear on page 6.) o Corporation, Limited Liability Company or Partnership (Corporate Resolutions, Operating Agreement or Partnership Agreement must be enclosed.) o Trust Trustee’s Name: Trust Date: o Other: Provide detailed information in the space immediately below.
Form of Ownership. Check the appropriate box (one only) to indicate form of ownership. If the subscriber is a Custodian, Corporation, Partnership or Trust, please provide the additional information requested. o Individual o Joint Tenants with Right of Survivorship (Both signatures must appear on page 6.) o Corporation, Limited Liability Company or Partnership (Corporate Resolutions, Operating Agreement or Partnership Agreement must be enclosed.) o Trust Trustee’s Name: _________________________________________ Trust Date: _____________________________________________ o Other: Provide detailed information in the space immediately below. _________________________________________________________ _________________________________________________________
Form of Ownership. Please indicate the form in which you will hold title to your Promissory Notes. Please consider this election carefully. Once your subscription is accepted, a change in the form of title constitutes a transfer of the Promissory Notes and will therefore be restricted by the terms of the Promissory Notes and the Act. Purchaser should seek the advice of an attorney in deciding in which of the forms to take ownership of the Promissory Notes as different forms of ownership can have substantially varying gift tax, estate tax, income tax and other consequences.
Form of Ownership. 1. The ownership and other property rights resulting from the project shall belong to, respectively, the Lead Partner or the Partners.
Form of Ownership. Please indicate the form of ownership that the Subscriber desires for the Shares: _____ Individual _____ Joint Tenants with Right of Survivorship _____ Tenants in Common _____ Community Property _____ Trust _____ Corporation _____ Partnership _____ Other: ________________________ By signing this agreement the subscriber has not waived any rights under the Securities Act of 1933 and the Securities Exchange Act of 1934.
Form of Ownership. Each Family Shareholder shall hold his, her or its Shares of record in his, her or its name and not in the name of a broker or other nominee. Notwithstanding the preceding, Shares may be held in the name of Miramar Fiduciary Corporation, as nominee for the Family Shareholder. Miramar Fiduciary Corporation will keep accurate records recording the beneficial owner of any such Shares held in its name as nominee and shall provide such information to the Company upon the Company’s request.
Form of Ownership. Check the appropriate box (one only) to indicate form of ownership. If the Buyer is a Custodian, Corporation, Partnership or Trust, please provide the additional information requested. ❑ Individual ❑ Joint Tenants with Right of Survivorship (both signatures must appear on page 12) ❑ Corporation or Partnership (Corporate Resolutions or Partnership Agreement must be enclosed) ❑ Trust (Signature and title pages of Trust Agreement and all amendments must be enclosed) Trustee’s Name: Trust Date: ❑ Other: Provide detailed information below:
Form of Ownership. Please indicate the form in which you will hold title to your interest, please consider carefully. Once your subscription is accepted, a change in the form of title constitutes a transfer of the membership interest and will therefore be restricted by the terms of the Operating Agreement and the Act. Purchaser should seek the advice of an attorney in deciding in which of the forms to take ownership of the shares because different forms of ownership can have varying gift tax, estate tax, income tax and other consequences.
Form of Ownership. Check the appropriate box (one only) to indicate form of ownership. If the subscriber is a Custodian, Corporation, Partnership or Trust, please provide the additional information requested. [ ] Individual [ ] Joint Tenants with Right of Survivorship (Both signatures must appear in Item 7) [ ] Corporation or Partnership (Corporate Resolutions or Partnership Agreement must be enclosed) [ ] XXX [ ] XXXXX [ ] Pension or Profit Sharing Plan [ ] Trust Trustee's Name: __________________________________________ Trust Date: ______________________________________________ [ ] Other: Provide detailed information in the space immediately below.
Form of Ownership. Please indicate the form of ownership you desire. ________ Individual or entity or trust (one signature required, unless otherwise required by organization documents) ________ Joint Tenants with right of survivorship (both parties must sign) ________ Tenants-in-Common (all parties must sign) ________ Community Property (one signature required if Shares and Warrants held in one name, i.e., ranging spouse; two signatures required if Shares and Warrants are held in both names) ______________________________________________________________ Please PRINT here the exact name(s) in which you wish the Shares and Warrants registered. ACCEPTED: BOSTON OMAHA CORPORATION By: ________________________________ Name: Xxxx X. Xxxxx Title: President Dated: June ___, 2015 SIGNATURE PAGE FOR PARTNERSHIP/LIMITED LIABILITY COMPANY INVESTORS Note: The partner(s), manager(s) or member(s) authorized to bind the partnership or limited liability company must sign and include a copy of the partnership, limited liability company or operating agreement, including any amendments. The agreement should include the date of formation of the partnership or limited liability company, a list of all partners or members (and managers, if any), the appropriate language authorizing this type of investment and the power of the general partner(s) or member(s) or manager(s) to sign on behalf of such entity. __________________________________________ Name of Partnership/Limited Liability Company (please print or type) By: _______________________________________ (Signature of a General Partner/Manager/Member) Taxpayer Identification No.: ___________________________ E-mail Address: Principal Business Offices: ____________________________________ ____________________________________ ____________________________________ ____________________________________ Mailing Address ____________________________________ (if different): ____________________________________ ____________________________________ ____________________________________ Attention: ____________________________ Executed at _____________________, ____________________ City State this _______ day of June, 2015. EXHIBIT A PURCHASER QUESTIONNAIRE INSTRUCTIONS TO PURCHASER QUESTIONNAIRE BOSTON OMAHA CORPORATION This questionnaire must be completed by all investors. In order to subscribe as an investor for this offering, you must complete this questionnaire. If you have any questions concerning any of the information called for, or questions concerning...
