Form M-1 - Broker-Dealer Statement - 1989 (Page 2 of 6) in pdf

Form M-1 - Broker-Dealer Statement - 1989 Page 2

.................................................... Yes [ ] No [ ]

Please indicate to whom you wish

Filing Fee Enclosed as Follows:

Broker-Dealer Statement ...... $800.00

the fee receipt sent.

[ ] Attorney [ ] Firm

Send remittance to:

Personal checks not accepted.

Bureau of Investor Protection

Attorney's check, certified

and Securities,

check, bank check, money order

N.Y.S. Office of the Attorney General

only, payable to the N.Y.S.

Office of the Attorney General.

120 Broadway

New York, N.Y. 10271

D. been convicted of any crime?

.................................................... Yes [ ] No [ ]

E. used or been known by any other name?

.................................................... Yes [ ] No [ ]

F. if any answer to "A", "B", "C", "D", or "E" is "YES", attach

statement of full particulars.

3. Does registration furnish investment advice for compensation?

.................................................... Yes [ ] No [ ]

4. Have you sold securities to the public within the last three years?

.................................................... Yes [ ] No [ ]

5. Do you meet the net capital requirements as described in

NY Gen. Bus. Law Sec.352-k?

(If at any time you do not meet the net capital requirements, you must notify

NYS Dept. of Law.)

.................................................... Yes [ ] No [ ]

6. Are fingerprints on file with:

[ ] SEC [ ] NASD [ ] New York State

.................................................... Yes [ ] No [ ]

[ ] N.Y. or other major exchange, indicate which:

____________________________________________________________________________________

7. Registrant has been a securities broker for ______ yrs.

8. If actual control of registrant has changed during past five years give in detail the sources of

all registrant's capital:

Amount

Source

____________________________________________________________________________________

Form M-1 - Broker-Dealer Statement - 1989 Page 2