Form 133.13 - Application For Renewal Permit - 2012
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TEXAS PERMIT NO.
133.13
EXPIRATION DATE
Texas State Securities Board
P.O. Box 13167
Austin, Texas 78711-3167
Application for Renewal Permit
Must be submitted with the applicable renewal fee.
This application may be completed by the issuer or by a registered dealer. Each of the following
items must be completed to effect a renewal permit.
1.
Name of Issuer:
2.
Principal office of Issuer:
3.
Issuer’s principal office in Texas (if any):
4.
Correspondent:
Firm:
Address:
Telephone: (
)
5.
Issuer’s form of organization (e.g., corporation, trust, partnership, etc.):
6.
State of incorporation (if applicable):
7.
Date of incorporation (if applicable):
8.
Describe any legal or administrative proceedings of a material nature that have been
instituted in which the Issuer, its advisor, or any affiliate was named as a party. If you have
not previously notified the State Securities Board of such proceedings, please attach a
summary or copy of the pleadings.
06-13-2012
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