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Designation Of Investment Adviser Representatives IAR - Nebraska

Designation Of Investment Adviser Representatives Form. This is a Nebraska form and can be used in General Blue Sky Secretary Of State .
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Nebraska Department of Banking and Finance Commerce Court, 1230 "O Street, Suite 400 PO Box 95006Bureau of Securities Lincoln, NE 68509-5006http://www.ndbf.org/ (402) 471-3445 Form IAR Designation of Investment Adviser Representatives (firm name) hereby designates thefollowing investment adviser representatives for Nebraska. File a Form U-4, examination proof(s) and a $40 registration fee for e ach representative listed directly with IARD/CRD. This pagemay be reproduced if additional space is required. Except for execution, all information must be typed. Individual Name Title CRD or SSN Number Qualifying ExamsOn behalf of the above-named firm, I certify that the information set fo rth on this form, including attachments, is true to the best ofmy knowledge, the firm has reviewed the Form U-4 of each of the above-na med representatives, all Form U-4 amendments are filedwith IARD/CRD, and to the extent any previously submitted information is not amended, such information is currently accurate andcomplete. By: Authorized Signature Date Printed Name Title Page 1 of 1 Rev. 12/2004 Form IAR.doc American LegalNet, Inc. www.USCourtForms.com
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