State of Utah
DEPARTMENT OF COMMERCE
DIVISION OF CONSUMER PROTECTION
NOTICE OF EXEMPTION
pursuant to the
BUSINESS OPPORTUNITY DISCLOSURE ACT
Annual Notice of Exemption fee: $100.00 (Non-refundable)
______________________________________________________
Applicant’s Name
______________________________________________________
Date of Application
Please indicate whether this is an initial or renewal notice of exemption:
OFFICE USE ONLY
Permit Number: _________________
Date Issued: ____________________
Date Expires: ___________________
Receipt Number:_________________
[ ] INITIAL |
[ ] RENEWAL |
NOTICE OF EXEMPTION |
NOTICE OF EXEMPTION |
If you have any questions, please contact the Division at (801) 530-6601.
Please return the completed notice of exemption form and fee to:
Department of Commerce
Division of Consumer Protection
160 East 300 South
SM Box 146704
Salt Lake City, Utah 84114-6704
COMPLETE REVERSE SIDE — SIGNATURE REQUIRED
May2001
NOTICE OF EXEMPTION
The applicant submits this form pursuant to UCA § 13-15-4.5 and states as follows:
1.Applicant’s name is: _____________________________________________________________________
2.The name of the Applicant’s Franchise is: _____________________________________________________
3.The name under which the Applicant intends to or does transact business, if different than the nameofthefranchise, is: ___________________________________________________________________________________
4.Applicant’s principal business address is:_____________________________________________________
Street
_____________________________________________________
5.Applicant’s Federal Employer Identification number is: ___________________________________________
6.Applicant’s contact person is:
_______________________________________________________________________
Name
_______________________________________________________________________
Street |
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City |
State |
Zip Code |
______________________________ |
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__________________________________ |
Telephone Number |
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Facsimile Number |
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7.The Applicant states that it is in substantial compliance with the requirements of the Federal Trade Commission rule found at Title 16, Chapter I, subchapter d, Trade Regulation Rules, Part 436, Disclosure Requirements and Prohibitions Concerning Franchising and Business Opportunity Ventures.
DATED: ______________________ |
APPLICANT: |
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BY _______________________________________________ |
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ITS |
NOTE: Formmust be completely filled out or it will not be accepted.
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