SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
AMENDMENT TO THE MUNICIPAL ADVISOR'S MOST RECENT FORM MA-I
OMB Number: 3235-0681
Estimated average burden hours per response: 0.5
Form MA-I Applicant's Information
Submission Contact Information
Notification Information
Notification will automatically be sent to the Login CIK,
Submission Contact, and Primary Issuers. Specify additional
addresses below.
Please read the General Instructions for this form and other forms in the MA series, as well as its subsection, "Specific Instructions for Form MA-I," before completing this form. All italicized terms herein are defined or described in the Glossary of Terms appended to the General Instructions.
PART 1
Every municipal advisory firm
applying for registration or registered as a municipal advisor on Form MA, to provide information regarding each natural person who is an associated person of the firm and engages in municipal advisory activities on the firm's behalf (for purposes of Form MA-I, the "individual"); and
Every natural person (sole proprietor) applying for registration as a municipal advisor on Form MA, to provide additional personal information.
WARNING
Complete this form truthfully. False statements or omissions may
result in denial of a municipal advisor's application, revocation or
suspension of such registration, or criminal prosecution.
Form MA-I must be amended promptly whenever
any information previously provided becomes inaccurate. See
General Instruction 9.
Type of Filing:
This is an (check the appropriate box):
Initial Form MA-I
Before submitting this form, you must complete the Execution Page.
If you are required to make reportable disclosures in the Disclosure Reporting Pages, you must attach the supporting documentation.
If the individual is a non-resident
of the United States, you must attach a completed Form MA-NR signed by
the individual to
this Form MA-I at the time of initial filing of Form MA-I. See the General
Instructions.
Amendment to the most recent Form MA-I
Amendment to indicate that the individual is no longer an associated person of
the municipal advisory firm or no longer engages in municipal advisory activities on its behalf.
(If you check this box, complete only Item 1-A and Item 7 below.)
Item 1 Identifying Information
A. The Individual
If no middle name, enter NMN on that line.
B. Municipal Advisory Firms Where the Individual Is Employed
In providing your responses, please note that the definition of "employee"
for purposes of this form includes an independent contractor who engages in
municipal advisory activities on behalf of a municipal advisory firm.
See Glossary of Terms.
municipal advisory firm?
YES
NO
(sole proprietors not employed with any other firm enter 1).
(For individuals who are employed with more than one firm, provide
the information required by this Item 1-B for each such firm. For sole proprietors,
enter the legal name under which you conduct your municipal advisor-related
activities, and skip to Item 1-B.1.)
the individual is employed:
primarily conducted, if different from above:
municipal advisory firm commenced (MM/DD/YYYY):
with the above-named firm?
YES
NO
(1) Municipal Advisory Firm's Registration Information:
Notification will automatically be sent to the Login CIK, Submission Contact,
and Primary Issuers. Specify additional addresses below.
on Form MA as a municipal advisor? (Answer "Yes" if you have
already filed Form MA and your application for registration on that form has
been approved. Otherwise, answer "No.")
YESNO
(2) Office
Enter the requested information for each office of the municipal advisory firm
where the individual is or will be physically located, and each office from which the individual
is or will be supervised:
Located At
Supervised From
of Employment address a private residence?
A private residential address will not be included in publicly
available versions of this registration form.
YES
NO
Item 2 Other Names
Enter the following information for all other names that the individual
has used or is using, or by which the individual is known or has been known, other
than the individual´s legal name, since the age of 18.
This space should include, for example, nicknames, aliases, and names used
before or after marriage.
Item 3 Residential History
Starting with the current address, enter the following information
for all the individual´s residential addresses for the past 5 years. Leave no gaps
greater than three months between addresses. Report changes in an amendment
to this form as they occur in the future. Private residential addresses
will not be included in publicly available versions of this form.
Current Address
Item 4 Employment History
Provide complete employment history of the individual for the past 10 years. Include
the municipal advisory firm(s) entered in Item 1-B. Enter
the following information for each employer. Account for all time,
leaving no gaps longer than three months. Include full- and part-time
employment, self-employment, military service, and homemaking. Also
include statuses such as unemployed, full-time education, extended travel,
or other similar statuses. Such statuses should be entered in the space
provided below for "Name of Municipal Advisory Firm or Company."
Current Employer
YES
NO
YES
NO
Prior to the Above
Prior employment history must be entered in reverse chronological order.
Prior Address
YES
NO
YES
NO
Prior Address
YES
NO
YES
NO
Prior Address
YES
NO
YES
NO
Prior Address
YES
NO
YES
NO
Item 5 Other Business
proprietor, partner, officer, director,
employee,
trustee, agent or otherwise?
YES
NO
Item 6 Disclosure Information
IF THE ANSWER TO ANY OF THE QUESTIONS IN ITEMS 6A – 6J AND 6M IS "YES," PROVIDE DETAILS OF ALL EVENTS OR PROCEEDINGS ON THE APPROPRIATE DISCLOSURE REPORTING PAGES (DRPs).
One event or proceeding may result in the requirement to answer "Yes"
to more than one question below.
Refer to the Glossary of Terms for definitions or descriptions of italicized terms.
CRIMINAL ACTION DISCLOSURE
If the answer is "Yes" to any question below in Item 6A or 6B,
complete a Criminal Action DRP.
Item 6A.
(1) Has the individual ever:
guilty or nolo contendere ("no contest") to any charge
of a felony in a domestic, foreign, or military court?
YES
NO
YES
NO
(2) Based upon activities that occurred while the individual exercised
control over it, has an organization ever:
("no contest") in a domestic or foreign court to any charge
of a felony?
YES
NO
YES
NO
Item 6B.
(1) Has the individual ever:
(a) been convicted of any misdemeanor
or pled guilty or nolo contendere ("no contest") in a domestic,
foreign or military court to any charge of a misdemeanor involving:
municipal advisory activities or a municipal advisor-related or
investment-related business or any fraud, false statements or omissions,
wrongful taking of property, bribery, perjury, forgery, counterfeiting, extortion,
or a conspiracy to commit any of these offenses?
YES
NO
(b) been charged with any misdemeanor of the kind described
in 6B(1)(a)?
YES
NO
(2) Based upon activities that occurred while the individual exercised
control over it, has an organization ever:
contendere ("no contest") in a domestic or foreign court to
any charge of a misdemeanor of the kind specified in 6B(1)(a)?
YES
NO
specified in 6B(1)(a)?
YES
NO
REGULATORY ACTION DISCLOSURE
If the answer is "Yes" to any question below in Items 6C-6G(1),
complete a Regulatory Action DRP.
Item 6C.
Has the SEC or the CFTC ever:
(1) found the individual to have made a false statement
or omission?
YES
NO
(2) found the individual to have
been involved in a violation of any SEC or CFTC
regulation or statute?
YES
NO
(3) found the individual to have been a
cause of a denial, suspension, revocation, or restriction of the authorization
of a municipal advisor-related business or investment-related
business to operate?
YES
NO
(4) entered an order against the individual in connection with
municipal advisor-related or investment-related activity?
YES
NO
(5) imposed a civil money penalty on the individual, or ordered
the individual to cease and desist from any activity?
YES
NO
(6) found the individual to have willfully violated
any provision of the Securities Act of 1933, the Securities Exchange Act of 1934,
the Investment Advisers Act of 1940, the Investment Company Act of 1940,
the Commodity Exchange Act, or any rule or regulation under any of such
Acts, or any of the rules of the MSRB, or found the individal to have been
unable to comply with any provision of such Acts, rules or regulations?
YES
NO
(7) found the individual to have willfully aided,
abetted, counseled, commanded, induced, or procured the violation by any
person of any provision of the Securities Act of 1933, the
Securities Exchange Act of 1934, the Investment Advisers Act of 1940,
the Investment Company Act of 1940, the Commodity Exchange Act, or
any rule or regulation under any of such Acts, or any of the rules of the
MSRB?
YES
NO
(8) found the individual to have failed reasonably
to supervise another person subject to his or her supervision, with a view to
preventing the violation of any provision of the Securities Act of 1933, the
Securities Exchange Act of 1934, the Investment Advisers Act of 1940,
the Investment Company Act of 1940, the Commodity Exchange Act, or any
rule or regulation under any of such Acts, or any of the rules of the
MSRB?
YES
NO
Item 6D.
(1) Has any other federal regulatory agency or any state regulatory agency
or foreign financial regulatory authority ever:
(a) found the individual to have made a false statement or
omission or to have been dishonest, unfair or unethical?
YES
NO
(b) found the individual to have been
involved in a violation of municipal advisor-related
or investment-related regulation(s) or statute(s)?
YES
NO
(c) found the individual to have been a cause of a denial,
suspension, revocation, or restriction of the authorization of a
municipal advisor-related or investment-related
business to operate?
YES
NO
(d) entered an order against the individual in connection
with a municipal advisor-related or investment-related activity?
YES
NO
(e) denied, suspended, or revoked the individual's
registration or license or otherwise, by order, prevented the individual from
associating with a
municipal advisor-related or investment-related business or
restricted his or her activities?
YES
NO
(2) Has the individual ever been subject to any final order of a state
securities commission (or any agency or office performing like functions),
a state authority that supervises or examines banks, savings associations,
or credit unions, a state insurance commission (or any agency or office
performing like functions), a federal banking agency, or the
National Credit Union Administration, that:
(a) bars the individual from association with an entity regulated by
such commission, authority, agency, or office, or from engaging in the business
of securities, insurance, banking, savings association activities, or credit union
activities; or
YES
NO
(b) is based on violations of any laws or regulations that
prohibit fraudulent, manipulative, or deceptive conduct?
YES
NO
Item 6E.
Has any self-regulatory organization or commodities exchange ever:
(1) found the individual to have made a false
statement or omission?
YES
NO
(2) found the individual to have been involved
in a violation of its rules (other than a violation designated as a
"minor rule violation" under a plan approved by
the SEC)?
YES
NO
(3) found the individual to have been a cause of a
denial, suspension, revocation, or restriction of the authorization of a
municipal advisor-related or investment-related business to
operate?
YES
NO
(4) disciplined the individual by expelling or suspending him or her
from membership, barring or suspending the individual's association with its members, or
restricting the individual's activities?
YES
NO
(5) found the individual to have willfully violated
any provision of the Securities Act of 1933, the Securities Exchange Act of 1934,
the Investment Advisers Act of 1940, the Investment Company Act of 1940,
the Commodity Exchange Act, or any rule or regulation under any of such
Acts, or any of the rules of the MSRB, or found the individual to have been
unable to comply with any provision of such Acts, rules or regulations?
YES
NO
(6) found the individual to have willfully aided, abetted,
counseled, commanded, induced, or procured the violation by any person
of any provision of the Securities Act of 1933, the Securities Exchange Act of
1934, the Investment Advisers Act of 1940, the Investment Company Act
of 1940, the Commodity Exchange Act, or any rule or regulation under
any of such Acts, or any of the rules of the MSRB?
YES
NO
(7) found the individual to have failed reasonably
to supervise another person subject to your supervision, with a view to preventing
the violation of any provision of the Securities Act of 1933, the
Securities Exchange Act of 1934, the Investment Advisers Act of 1940,
the Investment Company Act of 1940, the Commodity Exchange Act, or
any rule or regulation under any of such Acts, or any of the rules of the
MSRB?
YES
NO
Item 6F.
attorney, accountant or federal contractor that was revoked or suspended?
YES
NO
Item 6G.
Has the individual been notified, in writing, that he or she is currently
the subject of any:
result in a "Yes" answer to any part of 6C, D or E?
YES
NO
INVESTIGATION DISCLOSURE
If the answer is "Yes" to Item 6G(2) below, complete an
Investigation DRP.
answer to any part of 6A, B, C, D or E? (If "Yes," complete the Investigation
Disclosure Reporting Page.)
YES
NO
CIVIL JUDICIAL ACTION DISCLOSURE
If the answer is "Yes" to any question below in Item 6H,
complete a Civil Judicial Action DRP.
Item 6H.
(1) Has any domestic or foreign court ever:
municipal advisor-related or investment-related activity?
YES
NO
in a violation of any municipal advisor-related or investment-related
statute(s) or regulation(s)?
YES
NO
municipal advisor-related or investment-related civil action
brought against the individual by a domestic jurisdiction or
foreign financial regulatory authority?
YES
NO
YES
NO
CUSTOMER COMPLAINT/ARBITRATION/CIVIL LITIGATION DISCLOSURE
If the answer is "Yes" to any question below in Item 6I,
complete a Customer Complaint/Arbitration/Civil Litigation DRP.
Item 6I.
(1) Has the individual ever been the subject of a municipal advisor-related
or investment-related, customer-initiated (written or oral) complaint that
alleged that he or she was involved in fraud, false statements, omissions, theft,
embezzlement, wrongful taking of property, bribery, forgery, counterfeiting, extortion,
or dishonest, unfair or unethical practices, which:
YES
NO
YES
NO
(2) Has the individual ever been the subject of a municipal advisor-related
or investment-related, customer-initiated arbitration or civil litigation
that alleged that he or she was involved in fraud, false statements, omissions,
theft, embezzlement, wrongful taking of property, bribery, forgery, counterfeiting,
extortion, or dishonest, unfair or unethical practices, which:
YES
NO
against the individual, regardless of amount, or;
YES
NO
YES
NO
TERMINATION DISCLOSURE
If the answer is "Yes" to any question below in Item 6J,
complete a Termination DRP.
Item 6J.
Has the individual ever voluntarily resigned, been discharged
or permitted to resign after allegations were made that accused him or her of:
investment-related statutes, regulations, rules, or industry standards
of conduct?
YES
NO
YES
NO
municipal advisor-related or investment-related
statutes, regulations, rules or industry standards of conduct?
YES
NO
FINANCIAL DISCLOSURE
Item 6K.
Within the past 10 years:
filed a bankruptcy petition or been the subject of an involuntary
bankruptcy petition?
YES
NO
exercised control over it, has an organization made a
compromise with creditors, filed a bankruptcy petition or been the
subject of an involuntary bankruptcy petition?
YES
NO
control over it, has a broker or dealer been the subject of an
involuntary bankruptcy petition, had a trustee appointed, or had a direct
payment procedure initiated under the Securities Investor Protection Act?
YES
NO
Item 6L.
or revoked a bond for the individual?
YES
NO
JUDGMENT/LIEN DISCLOSURE
If the answer is "Yes" to any question below in Item 6M,
complete a Judgment/Lien DRP.
Item 6M.
liens against the individual?
YES
NO
Item 7 Signature and Self-Certification
NOTE: In addition to completing Item 7, to the extent that the individual is
a non-resident, a Form MA-NR completed and signed by the individual must be
attached as an exhibit to this Form MA-I.
Complete Either Subpart A or Subpart B:
By typing a name in the signature field, the signatory acknowledges and
represents that the entry constitutes in every way, use, or aspect, his or her
legally binding signature.
A. For Municipal Advisory Firms filing this form:
The municipal advisory firm has obtained and retained written
consent from the individual that service of any civil action brought by,
or notice of any proceeding before, the SEC or any
self-regulatory organization in connection with the individual's
municipal advisory activities may be given by registered or
certified mail to the individual's address given in Item 1.
I, the undersigned, sign this Form MA-I on behalf of, and with the authority of,
the municipal advisory firm that is filing this form. The
municipal advisory firm and I both certify, under penalty of perjury under
the laws of the United States of America, that the information and statements made
in this Form MA-I, including exhibits and any other information submitted, are true
and correct, and that I am signing this Form MA-I as a
free and voluntary act.
B. For Natural Person Municipal Advisors (Sole Proprietors) filing this form:
The individual named below consents that service of any civil action brought by, or
notice of any proceeding before, the SEC or any
self-regulatory organization in connection with the individual's
municipal advisory activities may be given by registered or certified mail to
the individual's address given in Item 1.
I, the undersigned, certify, under penalty of perjury under the laws of the
United States of America, that the information and statements made in this Form MA-I,
including exhibits and any other information submitted, are true and correct,
and that I am signing this Form MA-I Execution Page as a free and voluntary act.
Full Legal Name of Municipal Advisor:
Enter all the letters of each name and not initials or other abbreviations.
If no middle name, enter NMN on that line.
Warning: Intentional misstatements or omissions of fact constitute Federal criminal violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).12.