Form M-1 - Broker-Dealer Statement - 1989 (Page 5 of 6) in pdf

Form M-1 - Broker-Dealer Statement - 1989 Page 5

(Indicate periods of self-employment and unemployment. Include all corporations or other entities

where you hold or held a substantial equity or controlling interest.)

From

Employer or Business Affiliation

Position Held and

Mo.

Yr.

Mo. Yr.

Name

Address

Type of Business

11. List name, residence and nature of employment of all account executives, securities

salespersons, customer's men,

and registered representatives employed to sell in NY State. These people must file or have on file

a NY Form M-2

or M-4. This question need not be answered by NASD member firms who have registered their

salespeople through

the CRD system.

Name

Address

Nature of Employment

____________________________________________________________________________________

Each of the undersigned, constituting all officers, directors, partners, and controlling principals of

the registrant, does hereby

state and represent that all statements contained herein are true and correct and understands that

any false statement

shall constitute a violation of Art. 23-A of the General Business Law. (Power of attorney is not

acceptable.)

Signature

Name and Title

Date

(Please type or print)

____________________________________________________________________________________

Form M-1 - Broker-Dealer Statement - 1989 Page 5