Washington > Secretary Of State > Blue Sky > Securities
Investment Adviser Fiscal Year End Report - Washington
| Investment Adviser Fiscal Year End Report Form. This is a Washington form and can be used in Securities Blue Sky Secretary Of State . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
STATE OF WASHINGTON DEPARTMENT OF FINANCIAL INSTITUTIONS P.O. Box 9033 Olympia, Washington 98507-9033 Telephone (360) 902-8760 TDD (360) 664-8126 FAX (360) 902-0524 Web Site: www.dfi.wa.gov/sd SECURITIES DIVISION INVESTMENT ADVISER FISCAL YEAR END REPORT (Due within 90 days of the end of fiscal year) Item 1. Investment Adviser Firm Name __________________________________________________ State of Adviser's Principal Place of Business _______________________ Item 2. Form ADV Note: You are required to review and file an annual updating amendment to Part 1 of your Form ADV and upload an updated annual updating amendment to Part 2 of your Form ADV within 90 days of the end of your fiscal year. Part 1 must be filled out and filed on IARD. Part 2 must be uploaded to IARD. IARD No. Fiscal Year ______________ ______________ Date last annual updating amendment to Form ADV Part 1 was filed on IARD: Date last annual updating amendment to Form ADV Part 2 was uploaded to IARD: Item 3. Financial Report ____________________ ____________________ Note: Attach a copy of the investment adviser's balance sheet dated as of the end of its most recent fiscal year to this form. An interim financial statement will not satisfy this requirement. The balance sheet must be prepared in accordance with generally accepted accounting principles (GAAP). Is the investment adviser able to meet its obligations and pay its debts as they come due in the ordinary course of business? For an investment adviser whose principal place of business is in Washington State: Yes No Note: If the investment adviser has discretion, the balance sheet must show a net worth of at least $10,000, and if the investment adviser has custody of client funds or securities, it must show a net worth of at least $35,000 absent an exception. Does the firm have discretionary authority over client funds or securities? Does the firm have custody of client funds or securities? Does the firm have a surety bond in place? If yes, what is the amount and effective date of the bond? Does the firm have a subordination agreement in place? If yes, what is the current amount and effective date of the subordination agreement? This information regarding your subordination agreement must be included as a note on your balance sheet. Yes Yes Yes Yes No No No No ___________________ If no, did the firm previously have a subordination agreement? Why is this agreement no longer in place? ______________________________________________ ___________________ Yes No For an investment adviser whose principal place of business is outside of Washington: Is the investment adviser in compliance with any net worth or capital requirements imposed by the state of its principal place of business? Item 4. Certification Yes No In submitting this report, I certify that I am a principal of the adviser and the information provided in this report is true and complete to the best of my knowledge. Name: Title: _________________________________ _________________________________ Typed Signature: ______________________________ Date: ______________________________ Please email this Fiscal Year End Report and your GAAP compliant Balance Sheet to IARenewal@dfi.wa.gov. Revised 10/26/2011 American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
