No Investment Adviser Activity In Arizona Form printable pdf download

No Investment Adviser Activity In Arizona Form

NO INVESTMENT ADVISER ACTIVITY IN ARIZONA

I, ________________________________________________________, a principal with

(Name of Principal)

____________________________________________________________ (the “IA Firm”), have

(Name of Investment Adviser)

conducted a review of the IA Firm’s records. The result of this review shows that investment

adviser activity has been conducted with ______________ Arizona residents prior to the IA

(Number of accounts)

Firm’s licensure as an Investment Adviser with the state of Arizona.

Attached is a list of all investment adviser activity conducted with Arizona residents prior to the

IA Firm’s licensure as an Investment Adviser with the state of Arizona. The list includes the names and

addresses of Arizona advisory clients, the amount of advisory fees charged to each Arizona client,

description of the advisory services provided, the date of any transactions, the name and amount of any

security purchased and price per share/unit, the number of shares/units purchased, the current value of the

security purchased, the profits and losses experienced by the clients, and any commissions generated on

these offers and sales. If the investment adviser relied upon an exemption for the advisory activity,

indicate the exemption relied upon.

_______________________

_______________________________________

(Date)

(Signature of Principal)

State of ________________________

County of ______________________

Subscribed and sworn to before me this

Notary’s Seal Here

______ day of __________________, 2_____.

_____________________________________

Notary Public

My Commission Expires: _________________

Rev. 1/2006

No Investment Adviser Activity In Arizona Form