Form MA Application For Municipal Adivsor Registration (SEC2898) {MA}

FORM MA APPLICATION FOR MUNICIPAL ADVISOR REGISTRATION ANNUAL UPDATE OF MUNICIPAL ADVISOR REGISTRATION AMENDMENT OF A PRIOR APPLICATION FOR REGISTRATION OMB APPROVAL OMB Number: 3235-0681 Expires: May 31, 2017 Estimated average burden hours per initial response. . . . . . . . . . 3.5 per annual amendment. . . . . . . 1.5 per other amendment. . . . . . . . 0.5 Please read the General Instructions for this form and other forms in the MA series, as well as its subsection, "Specific Instructions for Certain Items in Form MA," before completing this form. All italicized terms herein are defined or described in the Glossary of Terms appended to the General Instructions. PART I This form must be completed by municipal advisors that are organized entities, including sole proprietors (referred to herein as "municipal advisory firms" or "firms," unless the context indicates otherwise). WARNING: Complete this form truthfully. False statements or omissions may result in denial of application, revocation of registration, administrative or civil action, or criminal prosecution. Form MA must be amended promptly upon the occurrence of certain material events, and updated at least annually, within 90 days of the end of the municipal advisor's fiscal year, or, if a sole proprietor, the municipal advisor's calendar year. See General Instruction 8. Type of Filing: This is an (check the appropriate box): Initial application to register as a municipal advisor with the SEC. Execution Page: After completing this form, you must complete the Execution Page. Supporting Documentation: If you are required to make reportable disclosures in the Disclosure Reporting Pages, you must attach the supporting documentation. Non-Resident Applicants: If you are a non-resident of the United States, certain additional requirements must be met at the time of filing your application, or processing of your application may be delayed. See General Instruction 2.c. and subsection "General Instructions to Form MA-NR" of the General Instructions. Annual update of municipal advisor's Form MA, for fiscal year ended ______, or, if a sole proprietor, for calendar year ended December 31, _____. Execution Page: After completing this form, you must complete the Execution Page. Changes: Are there changes in this annual update to information provided in the municipal advisor's most recent Form MA, other than the updated Execution Page? Yes No Amendment (other than annual update) to any part of the municipal advisor's most recent Form MA. Execution Page: After completing this form, you must complete the Execution Page. SEC 2898 (4/14) American LegalNet, Inc. www.FormsWorkFlow.com Item 1 Identifying Information A. Full Legal Name of the Firm: (1) Firm Name: ______________________________________________________ Organization CRD No., if any: _____________ (2) Sole Proprietor: If the applicant is a sole proprietor, check the box below, and provide full last name, first name, middle name, and suffix, if any: Enter all the letters of each name and not initials or other abbreviations. If no middle name, enter NMN on that line. __________________ _______________ _____________ ________ Last Name First Name Middle Name Suffix Individual CRD No., if any: _____________ (3) Name Change: If full legal name has changed since the municipal advisor's most recent Form MA, check here and provide the previous full legal name. ______________________________________________ B. Doing-Business-As (DBA) Name: (1) If the name under which municipal advisor-related business is primarily conducted is different from Item 1-A., check here and provide the DBA name. ________________________________________________________________________ (2) Previous DBA Name: If name under which municipal advisor-related business is primarily conducted has changed since the municipal advisor's most recent Form MA, check here and provide the previous name under which the municipal advisor-related business was primarily conducted. _________________________________________ (3) Additional Names: (a) Is municipal advisor-related business conducted under any additional names? (b) If "Yes," list any additional names on Section 1-B of Schedule D. Yes No C. (1) IRS Employer Identification Number: ______________________________ (2) If the applicant (such as a sole proprietor) has no employer identification number, provide the applicant's Social Security Number: ________________________________ The Social Security Number will not be included in publicly available versions of this registration form. 2 American LegalNet, Inc. www.FormsWorkFlow.com D. Registrations (1) Form MA-T Registration: Was the applicant previously registered on Form MA-T as a municipal advisor? Yes No If "Yes," enter the SEC File No. MA-T: ______________ (2) Other Registrations: Is the applicant registered as or with any of the following? Check all that apply. For each registration box you check, provide the requested file number(s). An applicant firm should NOT provide the organization CRD number, or other specified number, of any of its organizational affiliates, or the individual CRD number of its officers, employees, or natural person affiliates. Municipal Advisor SEC File No.: _________ Municipal Securities Dealer SEC File No.: _________ Broker-Dealer SEC File No.: _________ Organization CRD No.: ___________ Investment Adviser SEC-Registered SEC File No.: ________ Organization CRD No.: ___________ Exempt Reporting Adviser SEC File No.: ________ Organization CRD No.: ___________ Investment Adviser Registration in a US State or Other US Jurisdiction: If applicant is registered in a US state or other jurisdiction as an investment adviser, check the Registered in US State or Other US Jurisdiction box below and enter the organization CRD Number. In the table below, check the box for each US state or jurisdiction in which the applicant is so registered. Registered in US State or Other US Jurisdiction Check All That Apply Check All That Apply Organization CRD No. ___________ US State or Jurisdiction Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Code AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN US State or Jurisdiction Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina Code MT NE NV NH NJ NM NY NC ND OH OK