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Form MA-W Notice Of Withdrawal From Registration As Municipal Advisor (SEC2901) MA-W - Official Federal Forms

Form MA-W Notice Of Withdrawal From Registration As Municipal Advisor (SEC2901) Form. This is a national form and can be used in Securities And Exchange Commission .
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FORM MA-W OMB APPROVAL OMB Number: 3235-0681 Expires: February 28, 2017 Estimated average burden hours per response. . . . . . . . . . . . . . . . 0.5 NOTICE OF WITHDRAWAL FROM REGISTRATION AS A MUNICIPAL ADVISOR Please refer to the General Instructions for forms in the MA series before completing this form. All italicized terms herein are defined or described in the Glossary of Terms appended to the General Instructions. A municipal advisor must complete this Form MA-W to withdraw its municipal advisor registration with the SEC. WARNING: Complete this form truthfully. False statements or omissions may result in administrative or civil action or criminal prosecution. Item 1 Identifying Information A. Full Legal Name: The name entered here must be the same as the name entered on the registrant's most recent Form MA. Do not report a name change on this Form MA-W. ______________________________________________________________________________ B. SEC File Number: ______________ Item 2 Contact Person (for Municipal Advisory Firms) The registrant's contact person must be a principal or employee (not outside counsel) of the municipal advisor authorized to receive information and respond to questions about this Form MA-W. Name, title, and contact information: ________________________________________________________________ (name) (title) ________________________________________________________________ (number and street) ________________________________________________________________ (city) (state) (country) (postal code) ___________________________________ (area code) (telephone number) _____________________________@______________ (E-mail address) Item 3 Money Owed to Clients Has the registrant: A. Received any pre-paid municipal advisory fees for municipal advisory activities, including subscription fees for publications, that have not been delivered? Yes No If "yes," what is the amount owed for these pre-paid services (including subscriptions)? B. Borrowed any money from clients that has not been repaid? If "yes," what is the amount owed for these borrowed funds? $_______.00 Yes No $_______.00 SEC 2901 (4/14) American LegalNet, Inc. www.FormsWorkFlow.com Item 4 Advisory Contract Assignments Has the registrant assigned any municipal advisory contracts to another person that engages in municipal advisory activities? Yes No If yes, list on Section 4 of Schedule W1 each person to whom the registrant has assigned any such municipal advisory contracts and provide the requested information. Item 5 Judgments and Liens Are there any unsatisfied judgments or liens against the registrant? Yes No Item 6 Books and Records NOTE: Rule 15Ba1-8 under the Exchange Act requires a municipal advisor to preserve its books and records after the municipal advisor ceases to conduct or discontinues business as a municipal advisor. Provide in Schedule W1 the name and address of each person who has or will have custody or possession of the municipal advisor's books and records and each location at which any of such books and records are or will be kept. Item 7 Statement of Financial Condition If registrant answered "yes" to Item 3A, Item 3B, or Item 5, complete Schedule W2, disclosing the nature and amount of the registrant's assets and liabilities and net worth as of the last day of the month prior to the filing of this Form MA-W. 2 American LegalNet, Inc. www.FormsWorkFlow.com Execution For a Sole Proprietor: I, the undersigned, certify, under penalty of perjury under the laws of the United States of America, that the information and statements made in this Form MA-W, including exhibits and any other information submitted, are true. I further certify that the books and records of my municipal advisor-related business will be preserved and available for inspection as required by law, and that all information submitted on my most recent Form MA and Form MA-I is accurate and complete as of this date. I understand that if any information contained in this Form MA-W is different from the information contained on my Form MA and Form MA-I, the information on this Form MA-W will replace the corresponding entry on my Form MA and Form MA-I. Finally, I authorize any person having custody or possession of these books and records to make them available to authorized regulatory representatives. Signature: Printed Name: _________________________________ _________________________________ Date: Title: __________________________ __________________________ For a Municipal Advisory Firm: I, the undersigned, have signed this Form MA-W on behalf of, and with the authority of, the municipal advisor withdrawing its registration. The advisor and I both certify, under penalty of perjury under the laws of the United States of America, that the information and statements made in this Form MA-W, including exhibits and any other information submitted, are true. I further certify that the municipal advisor's books and records will be preserved and available for inspection as required by law, and that all information submitted on the municipal advisor's most recent Form MA is accurate and complete as of this date. The municipal advisor and I understand that if any information contained in this Form MA-W is different from the information contained on Form MA, the information on this Form MA-W will replace the corresponding entry on the municipal advisor's Form MA. Finally, I authorize any person having custody or possession of these books and records to make them available to authorized regulatory representatives. Signature: Printed Name: _________________________________ _________________________________ Date: Title: __________________________ __________________________ 3 American LegalNet, Inc. www.FormsWorkFlow.com FORM MA-W Schedule W1 Certain items in Form MA-W may require additional information on this Schedule W1. Use this Schedule W1 to report details for items listed below. Report only new information or changes/updates to previously submitted information. Do not repeat previously submitted information. SECTION 4 Advisory Contract Assignments Check here if this section is being completed: Complete the following information for each person to whom the registrant has assigned any advisory contract to provide municipal advisor-related services. Complete a separate Schedule W1 for each person to whom the registrant has assigned such a contract. Name and business address of the person to whom advisory contracts were assigned: _______
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