Form SRA — Addendum to Business Organization and Registration Forms
Statement of Compliance with New Hampshire Securities Laws
Part |- Business Identification and Contact Information
Business Name: Charter Contracting Company, LLC
Business Address (include city, state, zip): 500 Harrison Avenue, Suite 4R, Boston, MA 02118
Telephone Number: (857) 246-6811 E-mail: rdelhome@charter.us
Contact Person: Robert Delhome
Contact Person Address (if different):
Part Il- Check ONE of the following items in Part Il. If more than one item is checked, the form will be
rejected. [PLEASE NOTE: Most small businesses registering In New Hampshire qualify for the exemption in Part
ll, Item 1 below. However, you must insure that your business meets all of the requirements spelled out in A), B),
and C)}:
1. vy Ownership interests in this business are exempt from the registration requirements of the state of New
Hampshire because the business meets ALL of the following three requirements:
A) This business has 70 or fewer owners; and
B) Advertising relating to the sale of ownership interests has not been circulated; and
C) Sales of ownership interests — if any — will be completed within 60 days of the formation of this
business.
2. This business will offer securities in New Hampshire under another exemption from registration or will
notice file for federal covered securities. Enter the citation for the exemption or notice filing claimed -
3. This business has registered or will register its securities for sale in New Hampshire. Enter the date the
registration statement was or will be filed with the Bureau of Securities Regulation -
4, This business was formed in a state other than New Hampshire and will not offer or sell securities in
New Hampshire.
Part Ill - Check ONE of the following items in Part Ill:
1._¥_ This business is not being formed in New Hampshire.
2. This business is being formed in New Hampshire and the registration document states that any sale or
offer for sale of ownership interests in the business will comply with the requirements of the New
Hampshire Uniform Securities Act.
Part IV — Certification of Accuracy
(NOTE: The information in Part IV must be certified by: 1) all of the incorporators of a corporation to be formed; or
2) an executive officer of an existing corporation; or 3) all of the general pariners or intended general partners of a
limited partnership; or 4) one or more authorized members or managers of a limited liability company; or 5) one or
more authorized partners of a registered limited liability partnership or foreign registered limited liability
partnership.)
1 (We) certify that the information provided in this form is true and comple;
Name (print): Robert L. Delhome, Manager Signature:
Date signed:
Name (print): Signature:
Date signed:
Name (print): Signature:
Date signed: _
Rev. 3/08
