Illinois Secretary of State
Securities Department
421 E. Capitol Ave., 2nd Floor
Springfield, IL 62701
217-782-2256
IL FORM BB02
Statement for Basis of
Exemption from Waiting Period
and Disclosure Requirements
Name of Client or Prospective Client:
I, hereby, represent that the client or prospective client named above is either:
1. A natural person who has a net worth or joint net worth with that person’s spouse in excess of $1,000,000 at the time of the execution of
the Business Broker Agreement; or
2. A natural person who has an income or joint income with that person’s spouse in excess of $200,000 in the most recent fiscal year; or
3. A company, business or other non-natural person that has a total asset value in excess of $1,000,000, and has been in existence for at
least nine months and was not formed for the purposes of the subject transaction; or
4. A company, business or other non-natural person that has gross revenues or gross sales in excess of $200,000 in the most recent fiscal
year, and has been in existence for at least nine months and was not formed for the purposes of the subject transaction; or
5. A company, business or other non-natural person in which at least 90 percent of the entity interest is owned by persons who meet any of
the tests set forth in paragraph 1, 2, 3 or 4 above.
I, hereby, state that this representation is true and correct.
Printed by authority of the State of Illinois. November 2015 — 100 — SEC 316.1
Name of Client Signature
