STATE OF WASHINGTON
DEPARTMENT OF FINANCIAL
INSTITUTIONS
INVESTMENT ADVISER
SECURITIES DIVISION
PO Box 9033
FISCAL YEAR END REPORT
Olympia, WA 98501-9033
(Due within 90 days of the end of the fiscal year)
(360) 902-8815
IALicensing@dfi.wa.gov
1. INVESTMENT ADVISER
Full Legal Name:
CRD No.:
Primary Business Name:
Fiscal Year:
State of Principal Place of Business:
Legal Status:
2. FORM ADV
Date of annual updating amendment to Form ADV Part 1 filed on IARD:
Date of annual updating amendment to Form ADV Part 2 uploaded to IARD:
Are there any
changes to Form ADV Part 2 since the last annual updating?
Yes
No
3. FINANCIAL REPORT
Date of adviser’s balance sheet:
Is the investment adviser able to meet its obligations and pay its debts as they
Yes
No
come due in the ordinary course of business?
For an investment adviser whose principal place of business is in Washington State:
Yes
No
Does the firm have discretionary authority over client funds or securities?
Yes
No
Does the firm have custody of client funds or securities?
Yes
No
Does the firm have a surety bond?
Amount
If yes, what is the amount and effective date?
Date
Yes
No
Does the firm have a subordination agreement?
Amount
If yes, what is the amount and effective date?
Date
Yes
No
If no, did the firm previously have a subordination agreement?
Why is this agreement no longer in place?
For an investment adviser whose principal place of business is outside of Washington:
Is the investment adviser in compliance with any net worth or capital
Yes
No
requirements imposed by the state of its principal place of business?
4. CERTIFICATION
In submitting this report, I certify that I am a principal of the investment adviser and the information provided in
this report is true and complete to the best of my knowledge.
Name and Title:
Date:
Typed Signature:
Phone Number:
Please email this Fiscal Year End Report and Balance Sheet to
IARenewal@dfi.wa.gov
Rev. 01/2013
INSTRUCTIONS on the next page →
1
2
