Official Federal Forms > Securities And Exchange Commission
Form X-17A Annual Audited Report Part III (SEC1410) X-17A-5 - Official Federal Forms
| Form X-17A Annual Audited Report Part III (SEC1410) Form. This is a national form and can be used in Securities And Exchange Commission . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
UNITED STATES OMB APPROVAL SECURITIES AND EXCHANGE COMMISSION OMB Number: 3235-0123 Washington, D.C. 20549 Expires: January 31, 2007 Estimated average burden hours per response.. . . . . 12.00 ANN UAL AUDITED REPORT FORM X-17A-5 SEC FILE NUMBER PART III 8- FACING PAGE Information Required of Brokers and Dealers Pursuant to Section 17 of th e Securities Exchange Act of 1934 and Rule 17a-5 Thereunder REPORT FOR THE PERIOD BEGINNING ______________________________ AND ENDING ______________________________ MM/DD/YY MM/DD/YY A. REGISTRANT IDENTIFICATION NAME OF BROKER-DEALER: OFFICIAL USE ONLY ADDRESS OF PRINCIPAL PLACE OF BUSINESS: (Do not use P.O. Box No.) FIRM I.D. NO. ________________________________________________________________________________ ___________________________________ (No. and Street) ________________________________________________________________________ _____________________________________________ (City) (State) (Zip Code)NAME AND TELEPHONE NUMBER OF PERSON TO CONTACT IN REGARD TO THIS REPORT ________________________________________________________________________ _____________________________________________ (Area Code Telephone Number) B. ACCOUNTANT IDENTIFICATION INDEPENDENT PUBLIC ACCOUNTANT whose opinion is contained in this Report* ________________________________________________________________________ _____________________________________________ (Name if individual, state last, first, middle name) ________________________________________________________________________ _____________________________________________ (Address) (City) (State) (Zip Code)CHECK ONE: Certified Public Accountant Public Accountant Accountant not resident in United States or any of its possessions. FOR OFFICIAL USE ONLY *Claims for exemption from the requirement that the annual report be cov ered by the opinion of an independent public accountantmust be supported by a statement of facts and circumstances relied on as the basis for the exemption. See Section 240.17a-5(e)(2) Potential persons who are to respond to the collection of SEC 1410 (06-02) information contained in this form are not required to respond unless the form displays a currently valid OMB control number. American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 OATH OR AFFIRMATION I, ________________________________________________________________________ ___ , swear (or affirm) that, to the best of my knowledge and belief the accompanying financial statement and support ing schedules pertaining to the firm of ________________________________________________________________________ _____________________________________ , as of _________________________________________________, 20________, are true and correct. I further swear (or affirm) that neither the company nor any partner, proprietor, principal officer or d irector has any proprietary interest in any accountclassified solely as that of a customer, except as follows: ________________________________________________________________________ __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ __________________________________________________ _________________________________________ Signature _________________________________________ Title_________________________________________ Notary Public This report ** contains (check all applicable boxes): (a) Facing Page. (b) Statement of Financial Condition. (c) Statement of Income (Loss). (d) Statement of Changes in Financial Condition. (e) Statement of Changes in Stockholders Equity or Partners or Sole Proprietors Capital. (f) Statement of Changes in Liabilities Subordinated to Claims of Creditors. (g) Computation of Net Capital. (h) Computation for Determination of Reserve Requirements Pursuant to Rule 1 5c3-3. (i) Information Relating to the Possession or Control Requirements Under Rul e 15c3-3. (j) A Reconciliation, including appropriate explanation of the Computation o f Net Capital Under Rule 15c3-1 and the Computation for Determination of the Reserve Requirements Under Exhibit A of Rule 15c3-3. (k) A Reconciliation between the audited and unaudited Statements of Financi al Condition with respect to methods of consolidation. (l) An Oath or Affirmation. (m) A copy of the SIPC Supplemental Report. (n) A report describing any material inadequacies found to exist or found to have existed since the date of the previous audit.** For conditions of confidential treatment of certain portions of this fil ing, see section 240.17a-5(e)(3). American LegalNet, Inc. www.USCourtForms.com
|
|||||||
