Form Sec 1707 - Uniform Application For Investment Adviser Registration - Securities And Exchange Commission Page 15
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49Your Name _______________________________ CRD Number _______________
FORM ADV
Part 1A
Date _____________________________________ SEC 801-Number ____________
Page 15 of 16
Yes
No
(3) found you or any advisory affiliate to have been the cause of an investment-
related business having its authorization to do business denied, suspended,
revoked, or restricted?
(4) disciplined you or any advisory affiliate by expelling or suspending
you or the advisory affiliate from membership, barring or suspending you or
the advisory affiliate from association with other members, or otherwise
restricting your or the advisory affiliate’s activities?
F. Has an authorization to act as an attorney, accountant, or federal contractor granted
to you or any advisory affiliate ever been revoked or suspended?
G. Are you or any advisory affiliate now the subject of any regulatory proceeding that
could result in a “yes” answer to any part of Item 11.C., 11.D., or 11.E.?
For “yes” answers to the following questions, complete a Civil Judicial Action DRP:
Yes
No
H. (1) Has any domestic or foreign court:
(a) in the past ten years, enjoined you or any advisory affiliate in connection with any
investment-related activity?
(b) ever found that you or any advisory affiliate were involved in a violation of
investment-related statutes or regulations?
(c) ever dismissed, pursuant to a settlement agreement, an investment-related
civil action brought against you or any advisory affiliate by a state or foreign
financial regulatory authority?
(2) Are you or any advisory affiliate now the subject of any civil proceeding that could
result in a “yes” answer to any part of Item 11.H(1)?
Item 12
Small Businesses
The SEC is required by the Regulatory Flexibility Act to consider the effect of its regulations on small entities. In
order to do this, we need to determine whether you meet the definition of “small business” or “small organization”
under rule 0-7.
Answer this Item 12 only if you are registered or registering with the SEC and you indicated in response to Item
5.F(2)(c) that you have assets under management of less than $25 million. You are not required to answer this Item
12 if you are filing for initial registration as a state adviser, amending a current state registration, or switching from
SEC to state registration.
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