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Application For Temporary Or Continuing Hardship Exemption SADVSH - Missouri

Application For Temporary Or Continuing Hardship Exemption Form. This is a Missouri form and can be used in Securities Blue Sky Secretary Of State .
 Fillable pdf Last Modified 9/30/2005
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Robin Carnahan Secretary of State State of Missouri Securities Division 600 W. Main PO Box 1276 Jefferson City, MO 65102 Application for Temporary or Continuing Hardship Exemption Item 1 Identifying Information SEC File Number (if you have one): 801 - CRD Number (if you have one): A. Applicants full legal name (if you are a sole proprietor, state yo ur last, first and middle names): B. Principal Office and Place of Business Address (do not use a PO Box): (number and street) (city) (state) (county) (zip+4) If this address is a private residence, check this box: C. Name and telephone number of the individual filing this Form SADV-SH : (name) (title) (area code + telephone number) Item 2 Type of Exemption You are (check one): Requesting a Temporary Hardship Exemption; or Applying for a Continuing Hardship Exemption If you are requesting a temporary hardship exemption, this Form SADV-SH is for your (check one): Initial State Registration Amendment to State Registration (other-than-annual on IARD) FORM SADV-SH (01-05) PAGE 1 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2Item 3 Information Relating to the Hardship A. If you are filing to request a temporary hardship exemption, attach a se parate page that: 1. Describes the nature, extent, burden and/or expense incurred to time ly submit your filings in the electronic format. 2. Provides any other reasons why a temporary hardship exemption is war ranted. B. If you are applying for a continuing hardship exemption, your applicatio n will be granted or denied based on the following items. You should attach a separate page t hat: 1. Describes the reason(s) that the necessary hardware and software a re not available without unreasonable burden and expense. 2. Describes the burden and expense of employing alternative means (e. g. public library, service provider) to timely submit your filings in the electronic forma t. 3. Provides any other reasons why a continuing hardship exemption is wa rranted. Item 4 How to Submit your Form SADV-SH Sign this Form SADV-SH and mail the original to the Missouri Securities Division, 600 West Main, Jefferson City, MO 65101. You must preserve a copy of the Form SADV-SH for your re cords. Item 5 Execution I, the undersigned, have signed the Form SADV-SH on behalf of, and with the authority of, the adviser requesting a temporary hardship exemption or applying for a continuing h ardship exemption. The undersigned and the adviser represent that the information and statements made in this S ADV-SH, including any other information submitted, are true. The undersigned and the adviser further agree to wa ive any claim against the Commissioner for errors made in good faith that may occur when converting to electron ic format this Form SADV-SH or any paper filing made in reliance on a continuing hardship exemption. Signature: Date: Printed Name: Title: FORM SADV-SH (01-05) PAGE 2 American LegalNet, Inc. www.USCourtForms.com
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