Are you looking to become an Ohio resident? Are you familiar with the state's Form 3 Q filing requirement? This document must be completed in order to receive a certificate of residence, which is required for an individual to establish their residency in Ohio. It can seem intimidating, but the process doesn't have to be complicated and stressful. In this blog post, we'll go over everything you need to know about the process—from what form is needed and when it should be filed, all the way through providing proof of your status as a legal US resident or citizen. We'll also answer any questions you might have along the way. Read on if you are considering establishing your residency requirements in Ohio!
Question | Answer |
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Form Name | Ohio Form 3 Q |
Form Length | 3 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 45 sec |
Other names | 1933, Issuer, issuers, NotFill |
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File Number |
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77 South High Street, 22nd Floor |
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Columbus, Ohio |
Telephone |
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Form |
(614) |
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REPORT OF SALE OF |
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SECURITIES |
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1707.03(Q) |
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Claimant Must Not fill |
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Checked |
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In. |
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Notation |
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Division Record |
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Fee ($100/$50 Received |
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Prior filings |
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checked |
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Examined as to form |
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Amendment Requested |
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Accepted for |
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Filing |
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Record |
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Made |
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Examination |
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Requested |
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Exemption |
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(File) |
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(Date) |
(Amount) |
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(Description) |
(Price) |
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Note: Use this form to claim a section 1707.03(Q) exemption for securities sold in Ohio within 60 days of the filing of this form and not previously reported. Only those issuers relying on Section 4(2) of the Securities Act of 1933 are eligible to use this exemption. The
Submit to the Ohio Division of Securities, 77 South High Street, Columbus, Ohio
1.Issuer's full name
Payer’s Federal Tax Identification Number
2.Issuer's Address
(City, State, Zip) |
(Phone No.) |
3. |
State |
of |
Type of |
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incorporation/formation |
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entity |
(Corporation, Partnership, etc.)
4.Correspondence regarding this report should be sent to:
(Name) |
(Street) |
(City, State, Zip Code) |
(Phone No.) |
5.A section 1707.03(Q) claim of exemption is being made for the following securities sold in Ohio within 60 days of the filing of this form and not previously reported (use additional sheet, if necessary):
Type of |
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Date of |
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Number of |
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Price |
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Number of |
Securities Sold |
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Sale |
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Units Sold |
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per Unit |
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Purchasers |
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Note: O.A.C. rule
6.Confirm that the basis in law for this claim of exemption from Section 5 of the Securities Act of 1933 is pursuant to Section 4(2) of that Act. Note that Rules 504, 505 and 506 cannot be used as a basis for claiming the exemption pursuant to Section 1707.03(Q).
7.List the total number of persons who have purchased this offering to date, both in and outside of Ohio, including persons claimed on all previous Form
8.(a) List any commissions, discounts, or other remuneration paid or to be paid or given to any person, directly or indirectly, for sales in Ohio of the securities claimed on the Form
Name and address of person |
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Amount of |
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Percentage of |
receiving commission, etc. |
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commission, etc. |
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the Initial Offering Price |
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(b)Were above commissions, discounts, or other remuneration paid or given only to dealers or salesmen licensed
under Chapter 1707 of the Revised Code? |
YES |
NO |
9.Was an offering circular used in connection with the sales reported on this Form
YES |
NO |
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If yes, |
Copy attached or Previously submitted |
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10. Has this offering been terminated? |
YES |
NO |
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If yes, date of termination |
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11.Incorporated issuers not domiciled in this state or unincorporated issuers having a situs of its principal place of business outside this state must file a Form 11 or Form
SIGNATURE
The undersigned represents that the foregoing information is true as of the date hereof and agrees that this report shall be considered a written statement used for the purpose of selling securities in Ohio within the meaning of Section 1707.44(B) of the Ohio Revised Code. The individual signing this report on behalf of the issuer further represents that he/she is duly authorized by the issuer to execute and file this report.
Issuer or
Dealer
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(Full Name) |
B |
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y |
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(Signature) |
(Date) |
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(Name) |
(Official Capacity) |
The Division suggests Form
Com 4596 (Rev. 2/05)
EOE/ADA SERVICE PROVIDER |
FOR TTY USERS DIAL ORS |