Form Vt-1 - Invesment Adviser And Federal Covered Investment Adviser - 2013
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4Vermont Securities Division
INVESMENT ADVISER AND FEDERAL COVERED INVESTMENT ADVISER
VERMONT BRANCH OFFICE FORM (Form VT-1)
This form is being filed by (check one):
_____ INVESTMENT ADVISER
______ FEDERAL COVERED INVESTMENT ADVISER
_____ To initiate a branch office filing please complete items 1-10, 12 and Addendum to this form if required by
Item(s) 8 or 9. Registration requires a $100 fee payable to the “Department of Financial Regulation.”
_____ To amend branch office information, complete as set forth above. No fee required.
_____ To request termination of a branch office, please complete items 1-6, 10-12. No fee required.
_____________________________________________________________________________________________
1.
Name and principal place of business of the investment adviser or federally covered investment adviser
filing this form: ________________________________________________________________________
______________________________________________________________________________________
2.
Contact person for firm: _________________________________________________________________
Telephone number: _____________________________________________________________________
3.
Investment Adviser Firm CRD number: __________________________________________
4.
Vermont Branch Office #: ________________________________________________________________
5.
Physical location of branch office (include street address, suite or room number, city, state and zip code):
______________________________________________________________________________________
______________________________________________________________________________________
Mailing address (if different from above): ___________________________________________________
______________________________________________________________________________________
If address is being amended, indicate previous location: ________________________________________
______________________________________________________________________________________
6.
Branch office phone number: _____________________________________________________________
7.
Name and Central Registration Depository number of manager/resident investment adviser representative
in charge: _____________________________________________________________________________
8.
Is this office owned, leased, or rented by any person other than the firm filing this form?
_____ NO
_____ YES
(If “YES”, file Addendum)
9.
Will business be conducted at this branch office under any name other than that of the above-named firm?
_____ NO
_____ YES
(If “YES”, file Addendum)
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