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Financial Certification IAFC - Wisconsin
| Financial Certification Form. This is a Wisconsin form and can be used in Securities Blue Sky Secretary Of State . |
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ยง551.406(1)(b), Wis. Stats. and 5.01(2), Wis. Adm. Code STATE OF WISCONSIN DEPARTMENT OF FINANCIAL INSTITUTIONS DIVISION OF SECURITIES th 345 West Washington Ave., 4 Fl. PO Box 1768 Madison, WI 53701-1768 (608) 266-2139 TTY: (608) 266-8818 Internet: www.wdfi.org FINANCIAL CERTIFICATION Pursuant to s. DFI-Sec 5.02, Wis. Adm. Code, every investment adviser whose principal office is located in Wisconsin and that collects advisory fees of $1,200 or more, six months or more in advance shall maintain a positive net worth at all times. If the investment adviser will have custody of client funds or securities, a $35,000 net capital must be maintained. This shall be in the form of cash, securities or other liquid assets. If the investment adviser is an individual, the capital used to meet the net capital requirement must be segregated from the individual's personal assets and used solely for the business for which the adviser is licensed. FIRM'S NAME: _____________________________________________________________________________ FIRM'S ADDRESS: _________________________________________________________________________ _________________________________________________________________________ FIRM'S IARD NUMBER: ________________________ I, the undersigned, do hereby certify that the above mentioned firm has and will continue to maintain at all times, the net capital sufficient to meet the requirement in s. DFI-Sec 5.02, Wis. Adm. Code. I further certify that the accompanying financial statements are true to the best of my belief and knowledge. ___________________________________________________________________________________________ Typed Name and Title of an Officer of the Company _________________________________________________________ Signature _______________________________ Date This document can be made available in alternate formats upon request to qualifying individuals with disabilities. DFI/DOS/IAFC(WI)(R11/12) American LegalNet, Inc. www.FormsWorkFlow.com
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