Last updated: 8/14/2006
Deferral Request Form-Broker-Dealer {DFRRLBD}
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Description
THE COMMONWEALTH OF MASSACHUSETTS SECRETARY OF THE COMMONWEALTH SECURITIES DIVISION ONE ASHBURTON PLACE BOSTON, MASSACHUSETTS 02108 DEFERRAL REQUEST FORMBROKER DEALER ___________________________________________________ hereby amends its Name of Firm application for registration as a broker-dealer in Massachusetts and requests an extension of the thirty-day time period set forth in M.G.L. c.110A, Section 202(a) for action by the Massachusetts Securities Division with respect to the application. The undersigned hereby certifies that he/she has the authority to amend the application and make this request on behalf of ___________________________________________ ______ N ame of Firm and do so pursuant to that authority. __________________________________________ S ignature __________________________________________ Print Name and Title __________________________________________ Da te American LegalNet, Inc. www.USCourtForms.com
