Sponsors And Selling Agents Broker Dealer Statement - New York Department Of Law
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4STATE OF NEW YORK DEPARTMENT OF LAW
NY
FORM M-10
REAL ESTATE FINANCE BUREAU
rd
120 Broadway, 23
Floor
New York, NY 10271-0332
1-800-771-7755 TDD (for hearing impaired)
1-800-788-9898
SPONSORS AND SELLING AGENTS BROKER DEALER STATEMENT
All brokers and dealers whose principal business is in the offering, sale or promotion of condominiums, shares of
cooperative apartment corporations or commercial cooperative corporations, interests in homeowners associations,
timeshare projects, senior residences or any other participation interests in real estate, shall submit Form M-10.
Out-of-state or foreign organizations must attach a certified copy of a Designation for the Service of Process from the
Secretary of State. Attach additional sheets if space provided is inadequate. For assistance in completing this form, call
the Real Estate Finance Bureau: (212) 416-8106.
Name of Registrant: _________________________________________________ Telephone No.: _______________________
Address: _______________________________________________________________________________________________
Street
City
State
Zip
Other offices, if any _____________________________________________________________________________________
1. Registrant is a [ ] corporation
[ ] general partnership
[ ] limited partnership
[ ] sole proprietor
[ ] limited liability company
[ ] other: specify _____________________________________________________________
Organized under the laws of ___________________________________________________________________
2. Registrant is a [ ] sponsor.
[ ] selling agent. If a licensed real estate broker, give state license number and expiration date
_________________________________________________________________________
[ ] holder of unsold shares of a cooperative corporation.
[ ] purchaser for investment or resale of unsold shares of a cooperative corporation.
[ ] seller of interests in a homeowners association.
[ ] other: specify ______________________________________________________________
3. If registrant is a new or substitute sponsor, broker or dealer, has this information been disclosed in an offering plan or
amendment? Yes [ ] No [ ]
Filing fee .......................................... $300 (valid for 4 years)
Make check payable to the NYS Department of Law.
Additional fee for each partner,
Send remittance to:
proprietor, principal, member, officer, director,
Real Estate Finance Bureau
or manager............$ 15.00 each
NYS Department of Law
120 Broadway, 23
rd
Floor
Filing fee must accompany this statement. Payment by
New York, New York 10271
Attorney's check, company check, certified check, bank
check or money order. Personal checks not accepted.
REF M-10 (6/2016) Page 1 of 4
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