Investment Adviser Fiscal Year End Report - Department Of Financial Institutions

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STATE OF WASHINGTON

DEPARTMENT OF FINANCIAL INSTITUTIONS

SECURITIES DIVISION

P.O. Box 9033

Olympia, Washington 98507-9033



Telephone (360) 902-8760

TDD (360) 664-8126

FAX (360) 902-0524

Web Site:



INVESTMENT ADVISER FISCAL YEAR END REPORT

(Due within 90 days of the end of fiscal year)

Item 1. Investment Adviser

Firm Name

__________________________________________________

IARD No.

______________

State of Adviser’s Principal Place of Business

_______________________

Fiscal Year

______________

Item 2. Form ADV

Note: You are required to review and file an annual updating amendment to Part 1 of your Form ADV and upload an updated annual updating

amendment to Part 2 of your Form ADV within 90 days of the end of your fiscal year . Part 1 must be filled out and filed on IARD. Part 2 must be

uploaded to IARD.

Date last annual updating amendment to Form ADV Part 1

was filed on IARD:

____________________

Date last annual updating amendment to Form ADV Part 2

was uploaded to IARD:

____________________

Item 3. Financial Report

Note: Attach a copy of the investment adviser’s balance sheet dated as of the end of its most recent fiscal year to this form. An interim financial

statement will not satisfy this requirement. The balance sheet must be prepared in accordance with generally accepted accounting principles (GAAP).

Is the investment adviser able to meet its obligations and pay its debts as they come due

Yes

in the ordinary course of business?

For an investment adviser whose principal place of business is in Washington State :

Note: If the investment adviser has discretion, the balance sheet must show a net worth of at least $10,000, and if the investment adviser has custody of

client funds or securities, it must show a net worth of at least $35,000 absent an exception.

Does the firm have discretionary authority

over client funds or securities?

Yes

Does the firm have custody

of client funds or securities?

Yes

Does the firm have a surety bond

in place?

Yes

If yes, what is the amount and effective date of the bond?

___________________