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Investment Adviser Designation Of Supervisor IADS - Wisconsin
| Investment Adviser Designation Of Supervisor 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 345 West Washington Ave., 4 Fl. PO Box 1768 Madison, WI 53701-1768 (608) 266-2139 TTY: (608) 266-8818 Internet: www.wdfi.org th INVESTMENT ADVISER DESIGNATION OF SUPERVISOR Pursuant to s. DFI-Sec 5.05(7), Wis. Adm. Code, every registered investment adviser shall employ at its principal office or designated office of supervision in accordance with s. DFI-Sec 5.03(1), Wis. Adm. Code, at least one person designated in writing to the administrator to act in a supervisory capacity who is registered as an investment adviser representative in this state and has satisfied the examination requirement in s. DFI-Sec 5.01(5). FIRM INFORMATION FIRM'S NAME: ______________________________________________________________________________ FIRM'S ADDRESS ___________________________________________________________________________ ___________________________________________________________________________ DESIGNATED SUPERVISOR INFORMATION If the firm wishes to designate more than one supervisor, submit one form for each supervisor designated. NAME OF DESIGNATED SUPERVISOR: _________________________________________________________ HOME ADDRESS OF DESIGNATED SUPERVISOR: ____________________________________________ ____________________________________________ ADDRESS OF OFFICE OF EMPLOYMENT: (Must be Principal or Designated Office) ___________________________________________________ ___________________________________________________ DATE QUALIFIED/PENDING IN WISCONSIN: __________________SUPERVISOR CRD #________________ THIS FORM IS TO BE SIGNED BY ANY OFFICER OF THE FIRM ___________________________________________________________________________________ TYPED NAME AND TITLE OF SIGNATORY _________________________________________________ SIGNATURE ______________________________ DATE This Division is to be notified within 10 days of any change in designated supervisor. Failure to do so will be cause for a delinquent filing fee of $100 pursuant to s. DFI-Sec 7.01(6)(g), Wis. Adm. Code. (Please refer to s. DFI 5.04(4), Wis. Adm. Code.) This document can be made available in alternate formats upon request to qualifying individuals with disabilities. DFI/DOS/IADS(WI)(R01/12) American LegalNet, Inc. www.FormsWorkFlow.com
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