Form X-17a-5 - Annual Audited Report Part Iii - U.s. Securities And Exchange Commission
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1
2UNITED STATES
OMB APPROVAL
SECURITIES AND EXCHANGE COMMISSION
OMB Number:
3235-0123
Washington, D.C. 20549
Expires:
March 31, 2016
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hours per response.. . . . . 12.00
ANNUAL AUDITED REPORT
FORM X-17A-5
SEC FILE NUMBER
PART III
8-
FACING PAGE
Information Required of Brokers and Dealers Pursuant to Section 17 of the
Securities Exchange Act of 1934 and Rule 17a-5 Thereunder
REPORT FOR THE PERIOD BEGINNING______________________________ AND ENDING______________________________
MM/DD/YY
MM/DD/YY
A. REGISTRANT IDENTIFICATION
OFFICIAL USE ONLY
NAME OF BROKER-DEALER:
FIRM I.D. NO.
ADDRESS OF PRINCIPAL PLACE OF BUSINESS: (Do not use P.O. Box No.)
___________________________________________________________________________________________________________________
(No. and Street)
_____________________________________________________________________________________________________________________
(City)
(State)
(Zip Code)
NAME AND TELEPHONE NUMBER OF PERSON TO CONTACT IN REGARD TO THIS REPORT
_____________________________________________________________________________________________________________________
(Area Code – Telephone Number)
B. ACCOUNTANT IDENTIFICATION
INDEPENDENT PUBLIC ACCOUNTANT whose opinion is contained in this Report*
_____________________________________________________________________________________________________________________
(Name – if individual, state last, first, middle name)
_____________________________________________________________________________________________________________________
(Address)
(City)
(State)
(Zip Code)
CHECK ONE:
…
Certified Public Accountant
…
Public Accountant
…
Accountant not resident in United States or any of its possessions.
FOR OFFICIAL USE ONLY
*Claims for exemption from the requirement that the annual report be covered by the opinion of an independent public accountant
must be supported by a statement of facts and circumstances relied on as the basis for the exemption. See Section 240.17a-5(e)(2)
Potential persons who are to respond to the collection of
information contained in this form are not required to respond
SEC 1410 (06-02)
unless the form displays a currently valid OMB control number.
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