Form Cm-4 - Supplemental Commodity Salesperson Statement (Page 2 of 2) in pdf

Form Cm-4 - Supplemental Commodity Salesperson Statement Page 2

documentation about the occurrence of any of the above.

NOTE: No fee required to cancel registration. However, re-employment as a salesperson of

commodities after cancellation will require a new registration and payment of $25 filing fee.

4. [ ] CANCEL MY COMMODITY SALESPERSON REGISTRATION.

A $10.00, fee must accompany this statement. Personal checks not accepted.

Attorney's check, certified check, money order only payable to the N.Y.S

Office of the Attorney General. Remit to: Bureau of Investor Protection and Securities, 23rd

Floor, N.Y.S. Office of the Attorney General, 120 Broadway, New York, NY 10271.

DATED: ____________________ Signature: ______________________________

STATE OF ___________________

)

: SS.:

COUNTY OF __________________ )

________________________________, being duly sworn, deposes and

says that I am the ____________________ Commodity Salesperson described

above and I signed the above form. I have read the questions and answers

and information supplied, and they are true, accurate and complete.

__________________________________

(Signature of Affiant/Salesperson)

Sworn to before me this

_______ day of ___________, 19

(Notary signature and legible official stamp)

(spe)

**Found on the fee receipt for original filing

Form Cm-4 - Supplemental Commodity Salesperson Statement Page 2