0001301283-16-000004.txt : 20160712 0001301283-16-000004.hdr.sgml : 20160712 20160712161055 ACCESSION NUMBER: 0001301283-16-000004 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20160712 DATE AS OF CHANGE: 20160712 EFFECTIVENESS DATE: 20160712 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Formation Data Systems, Inc. CENTRAL INDEX KEY: 0001619133 IRS NUMBER: 461087596 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-266832 FILM NUMBER: 161764089 BUSINESS ADDRESS: STREET 1: 39141 CIVIC CENTER BLVD., SUITE 410 CITY: FREMONT STATE: CA ZIP: 94538-5818 BUSINESS PHONE: 415-361-7710 MAIL ADDRESS: STREET 1: 39141 CIVIC CENTER BLVD., SUITE 410 CITY: FREMONT STATE: CA ZIP: 94538-5818 D 1 primary_doc.xml X0707 D LIVE 0001619133 Formation Data Systems, Inc. 39141 CIVIC CENTER BLVD., SUITE 410 FREMONT CA CALIFORNIA 94538-5818 510-894-3867 DELAWARE None None Corporation true 2012 Mark Lewis c/o Formation Data Systems, Inc. 39141 Civic Center Drive, Suite 410 Fremont CA CALIFORNIA 94538 Executive Officer Director Anthony Bettencourt c/o Formation Data Systems, Inc. 39141 Civic Center Drive, Suite 410 Fremont CA CALIFORNIA 94538 Director Carl Ledbetter c/o Formation Data Systems, Inc. 39141 Civic Center Drive, Suite 410 Fremont CA CALIFORNIA 94538 Director Robert Schwartz c/o Formation Data Systems, Inc. 39141 Civic Center Drive, Suite 410 Fremont CA CALIFORNIA 94538 Director Eric Chan c/o Formation Data Systems, Inc. 39141 Civic Center Drive, Suite 410 Fremont CA CALIFORNIA 94538 Executive Officer Other Technology Decline to Disclose 06b false 2016-06-29 false true true true false 0 20000374 6000111 14000263 false 4 0 0 0 false Formation Data Systems, Inc. /s/ Eric Chan Eric Chan Chief Financial Officer 2016-07-11