Commodity Broker-Dealer Statement {CBD}

** File No. NY Form CBD(/) (for renewals only) STATE OF NEW YORK Office of the Attorney General INVESTOR PROTECTION COMMODITY BROKER-DEALER STATEMENT (Section 359-e(14) Gen. Bus. Law) Firm Principal Name Office Telephone No. Street Address City State Zip The registrant [ ] does [ ] does not maintain other offices or facilities. If it does, state where. 1. Is registrant now licensed, or otherwise qualified to transact securities or commoditiesbusiness in any other state? .............................. Yes [ ] No [ ] If "YES" attach list of states. 2.Has registrant, any officer, director, principal, partner, manager, supervisor, 10% or moreequity holder or any entity in which such individual was a principal ever: A. been suspended or expelled from membership in any securities or commodities exchange, association of securities or commodities dealers or investment or commodities trading advisors or counsel? ...................... Yes [ ] No [ ] B. had a license or registration as a securities or commodity dealer, broker, investment advisor, salesperson, futures commission merchant, associated person, commodity pooloperator or commodity trading advisor denied, suspended, revoked, cancelled or refused? .......... Yes [ ] No [ ] C. been enjoined or restrained by any court or government agency from: 1.the issuance, sale or offer for sale of securities or commodities? .....Yes [ ] No [ ]2.rendering securities or commodities advice or counsel? .. Yes [ ] No [ ]3.handling or managing trading accounts?.............................Yes [ ] No [ ]4.continuing any practices in connection with securities orcommodities?.Yes [ ] No [ ] ** Found on the fee receipt you received for your original filing. Found Fee Enclosed as Follows: Please indicate to whom you wish Commodity Broker-Dealerthe fee receipt sent. Statement........$100.00( ) Attorney ( ) Firm Send remittance to:Investor Protecti NYS Office of the Attorney General Personal checks not accepted. Attorney's check, bank check, check, money order andonly, payable to the NYSOffice of the Attorney General. Page 1of 3Investors - Form CBD American LegalNet, Inc. www.FormsWorkFlow.com New York, NY 10 D. Is any action or proceeding seeking the relief enumerated in A-C presently pending?...... Yes [ ] No [ ] E. been convicted of any crime?................... Yes [ ] No [ ] F. used or been known by any other name?.......... Yes [ ] No [ ] G. been the subject of any professional disciplinary proceeding?....................... Yes [ ] No [ ] H. been adjudged a bankrupt or made a general assignment for benefit or creditors; been the subject of a receivership or bankruptcy proceeding; been an officer, director, principal, partner, manager, supervisor or any 10% or more equity holder of any entity which was reor g anized in bankruptc y , ad j ud g ed a bankruptc y or made a g eneralassi g nment for benefit of creditors?......................... Yes [ ] No [ ] I. had a judgment entered against them or it which is presently unsatisfied? (Not including judgment involving domestic relations.)....... Yes [ ] No [ ] J. been a party in any litigation or administrative proceeding in which it is alleged that they or it committed fraud or otherwise violated any provision of the Martin Act or any other securities or commodities laws?................ Yes [ ] No [ ] K. if any answer to any of the above "YES", attach statement of full particulars. 3.Does registrant furnish investment advice for compensation?................................... Yes [ ] No [ ]4.Has re g istrant sold securities or commodities to the public within the last three y ears?.......... Yes[ ] No [ ] 5.Registrant has been a commodity broker-dealer since .6.If actual control of registrant has changed during past 5 years give in detail the sources of allregistrant's capital: Amount Source 7.Give the location of each business in which registrant has engaged during the preceding fiveyears. From To Mo./Yr Mo./Yr. Business Location and Nature 8.What t y pe of commodities do y ou sell? (for instance, numismatic coins, precious metals, bullion,precious metals leverage contracts, etc. Page 2of 3Investors - Form CBD American LegalNet, Inc. www.FormsWorkFlow.com 9.List below all mana g ers and supervisors in the emplo y of re g istrant. For each person listedattach a copy of Form CI-1. 10.List below the name and position of each officer, director, principal, partner, or any 10% ormore equity holder. For each person listed attach a copy of form CI-1. 11.List name, residence and nature of emplo y ment of all commodit y salespersons emplo y ed to sellin N.Y. State. These people must file or have on file a N.Y. Form CM-2 (Commodity Salesperson Statement). Name Address Nature of Employment All changes or amendments to this form must be submitted on N.Y. form CM-3 with a $10 fee. Registration will expire one year from filing. To renew your registration you must refile this form within 30 days of expiration. DATED: Signature: STATE OF ) : SS.: COUNTY ) , being duly sworn, deposes and says that I am the (Title) of Re g istrant and I si g ned the above form. I have read the questions and answers and information supplied, and they are true, accurate and complete (Signature of Affiant/Chief Executive Officer of Registrant) Sworn to before me this day of, 19 (Notary signature and legible official stamp) (spe) Page 3of 3Investors - Form CBD American LegalNet, Inc. www.FormsWorkFlow.com