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Addendum To Vermont Branch Office Form VT2 - Vermont
| Addendum To Vermont Branch Office Form Form. This is a Vermont form and can be used in Securities Blue Sky Secretary Of State . |
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Revised 4/17/2012 ADDENDUM TO INVESTMENT ADVISER AND FEDERAL COVERED INVESTMENT ADVISER VERMONT BRANCH OFFICE FORM (Form VT-2) This addendum must be completed for each branch office which will be owned, leased or rented by any person other than the firm filing a branch office form; or for any branch office which will conduct business under a name other than that of the firm filing a branch office form. 1. Name of investment adviser or federal covered investment adviser (same as item 1 on Form VT-1): ____________________________________________________________________________________ 2. Will business be conducted at this branch office under any name other than that of the above-named firm? _____NO _____YES If "YES", provide the name(s) under which business will be conducted at this location: ____________________________________________________________________________________ 3. What types of business or services will be offered at this office? Check all that apply. _____Insurance _____Investment Advice _____Law Office _____Accounting Services _____Securities _____Financial Planning _____Tax Advice _____Banking (Specify bank): _______________________________ _____Other please describe with specificity: ________________________________________________ 4. Is there any agreement or contract between the above-named applicant and any person concerning the operations at this office? _____NO _____YES If "YES", attach a copy of the agreement to this form. 5. What person(s) are responsible, directly or indirectly, for paying the expenses of this office? Please provide name, CRD number, address, and phone number for each: ______________________________________________________________________________________ ______________________________________________________________________________________ 6. This office will be: _____owned _____leased _____rented for purposes of conducting an investment advisory business. If this property will be owned, leased or rented by someone other than the investment advisor or federal covered investment adviser, attach a list with the name(s), address(es) and phone number(s) of the person(s) owning, leasing or renting such property. If owned, leased or rented by a corporation or partnership, attach the names, titles, addresses, and phone numbers of all officers, directors, and owners of such corporation or partnership. American LegalNet, Inc. www.FormsWorkFlow.com 7. By executing this form, the undersigned, in his or her individual capacity and on behalf of the above-named applicant firm hereby swears and affirms that all information on this form and all materials filed in connection with it are true, correct and complete. The undersigned stipulates, recites, acknowledges and agrees that if the Vermont Securities Division finds that any information contained in this application or in an amendment to this application is false, such finding shall constitute a violation of 9 V.S.A. § 5505. Signed: _____________________________________________ Date: ___________________________ Officer, Partner or Sole Proprietor of Applicant Firm _______________________________________________________________________________ Typed Name and Title of Signatory Please mail completed form to: Department of Financial Regulation, Attn: Securities Division, 89 Main Street, 2nd Floor Montpelier, VT 05602 Rev 4/17/2012 American LegalNet, Inc. www.FormsWorkFlow.com
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