Form Adv-W - Notice Of Withdrawal From Registration As An Investment Adviser (Page 5 of 11) in pdf

Form Adv-W - Notice Of Withdrawal From Registration As An Investment Adviser Page 5

FORM ADV-W (Paper Version)

NOTICE OF WITHDRAWAL FROM REGISTRATION AS AN INVESTMENT ADVISER

Form ADV-W

You must complete this Form ADV-W to withdraw your investment adviser registration with the SEC or one or

more state securities administrators. We use the term “you” to refer to the investment adviser withdrawing from

registration, regardless of whether the adviser is a sole proprietor, a partnership, a corporation, or another form

of organization.

WARNING:

Complete this form truthfully. False statements or omissions may result in administrative, civil or

criminal action against you.

Status

Check the box that indicates what you would like to do:

(i)

Withdraw from registration in all of the jurisdictions with which you are registered (or have an

application for registration pending) (a “full withdrawal”).

(ii)

Withdraw from registration in some, but not all, of the jurisdictions with which you are registered (or

have an application for registration pending) (a “partial withdrawal”).

If you are filing for full withdrawal, you must complete all items of this Form ADV-W. If you are filing for

partial withdrawal, follow the instructions below for the type of partial withdrawal you are filing.

If you are filing for partial withdrawal, indicate the jurisdictions from which you are withdrawing your investment

adviser registration (or application for registration):

(a)

The SEC;

Check this box if you are withdrawing your SEC registration and switching to state registration, or if

you are withdrawing your application for SEC registration. If you check this box (a), you must

complete only this Status Section, Items 1A through 1D, and the Execution Section. Do not complete

Item 1E and Items 2 through 8.

(b)

The state(s) for which the box(es) below are checked:

[ ] AL [ ] DC [ ] IA [ ] MN [ ] NM [ ] PR [ ] VI

[ ] AK [ ] FL [ ] KS [ ] MS [ ] NY [ ] RI

[ ] VA

[ ] AZ [ ] GA [ ] KY [ ] MO [ ] NC [ ] SC [ ] WA

[ ] AR [ ] GU [ ] LA [ ] MT [ ] ND [ ] SD [ ] WV

[ ] CA [ ] HI [ ] ME [ ] NE [ ] OH [ ] TN [ ] WI

[ ] CO [ ] ID [ ] MD [ ] NV [ ] OK [ ] TX [ ] WY

[ ] CT [ ] IL [ ] MA [ ] NH [ ] OR [ ] UT

[ ] DE [ ] IN [ ] MI [ ] NJ [ ] PA [ ] VT

If you check this box (b), you must complete all items of this Form ADV-W.

Form Adv-W - Notice Of Withdrawal From Registration As An Investment Adviser Page 5