Request For Withdrawal Of A Branch Office Nevada Form 360-2w
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1State of Nevada
Secretary of State
Securities Division
Request For Withdrawal of a Branch Office
Nevada Form 360-2W
To:
Office of the Secretary of State
Securities Division
Date
Ms. Terry Sanchez, Licensing Examiner
555 E. Washington Avenue, Suite 5200
Las Vegas, Nevada 89101
Firm's CRD No.
NOTE:
Please submit a separate form for each branch office. Attach separate sheet for any additional details.
1) Name of Nevada Registered Broker Dealer:
hereby requests withdrawal of branch registration for the branch located at:
STREET ADDRESS
CITY
ST
ZIP
2) Date branch will cease business:
3) Does the branch owe any money or securities to any customer or broker-dealer?
Yes
No
(a) Amount of money owed to:
Customers: $
Broker-Dealers: $
(b) Arrangements made for payment:
4) If you are currently under inspection by the Nevada Securities Division, you may NOT withdraw until the
inspection is completed and the fee is paid.
Yes
No
The registrant submitting this form and its attachments, if applicable, and the person executing it represent hereby that it,
and all materials filed in connection with it, contain a true, correct and complete statement of all required information.
Dated the
day of
,
(Type Name of Undersigned)
(Signature of Executive Officer, Partner, Sole Proprietor)
(Form Approved by the Office of the Secretary of State 6/99)
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