Application For Registration By Qualification Pursuant To Wac 460-33a - Mortgage Paper Securities

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APPLICATION FOR REGISTRATION BY QUALIFICATION
PURSUANT TO WAC 460-33A
Mortgage Paper Securities
Initial
Renewal
1. Name and address of registrant:___________________________________________________________
______________________________________________________________________________________
2. Name and address of issuer (if different from
registrant)________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
3. Name, address, telephone number and facsimile number (if any) of the person to contact with respect
to this filing:
______________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
4. Short description of securities sought to be registered (such as "undivided participation interests in
notes secured by deeds of trust on real estate located in Washington
state"):________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
5. Dollar amount of mortgage paper securities sought to be registered in
Washington:____________________________________________________________________________
6. Dollar amount of securities to be offered in all states (including
Washington):________________________
7. Anticipated maximum price per mortgage paper
security:_______________________________________
8. Fee ($100 for the first $100,000 of mortgage paper securities to be registered in this state plus 1/20 of
1% for any amount to be registered in excess of $100,000): ________________________ [the check
should be made payable to the Washington State Treasurer]
9. Fiscal year end: _________________
10. The issuer complies with the net worth or bond requirements by satisfying the requirements of (check
the appropriate box):
A.
WAC 460-33A-040(1)(a) - Tangible Net Worth of the greater of $100,000 or 10% of the
amount to be registered up to a maximum of $1,000,000; or
B.
WAC 460-33A-040(1)(b) - $100,000 Surety Bond; or

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