Form Lt-1 - Schedule A - For Individuals Applying For A License To Sell Living Trusts

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Schedule A of
Page 1
Form LT-1
Applicant:
Date:
(For individuals applying for a license to sell living trusts)
1. Applicant firm: (See Form LT-1, Item 1)
2. Individual's full name for whom this
Social Security Number:
Schedule is being completed:
3. Residence of individual: (Number and Street)
(City)
(State)
(Zip)
If this individual is affiliated with an Investment Advisor Firm other than the Applicant Firm,
complete the following:
4. Name of Firm:
5. Principal place of business:
(Number and Street)
(City)
(State)
(Zip)
6. Mailing Address:
(Number and Street or PO Box)
(City)
(State)
(Zip)
(If different from Item 5)
7. Telephone number of Firm:
(Area Code) (Number)
A completed Schedule A is required for each individual who will offer or sell living
trusts under the license of the applicant on Form LT-1. Pursuant to 6.12.1203, ARM,
the applicant must amend this form within thirty (30) days of the occurrence of any
change in the information contained on Form LT-1 or its attached schedules.
Orig. 10/97

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