NY Form CBD
** File No. _________
(1/87)
(for renewals only)
STATE OF NEW YORK
Office of the Attorney General
BUREAU OF INVESTOR PROTECTION AND SECURITIES
COMMODITY BROKER-DEALER STATEMENT
(Section 359-e(14) Gen. Bus. Law)
Firm
Principal
Name_______________________ Office__________________________________
Telephone No.______________
Street Address
City
State
Zip
The registrant [ ] does [ ] does not maintain other offices or facilities.
If it does, state where. _________________________________________________
____________________________________________________________________
1. Is registrant now licensed, or otherwise qualified to transact securities or
commoditie sbusiness in any other state? .............................. Yes [ ] No [ ]
If "YES" attach list of states.
2. Has registrant, any officer, director, principal, partner, manager, supervisor,
10% or more equity holder or any entity in which such individual was a principal
ever:
A. been suspended or expelled from membership in any securities or
commodities exchange, association of securities or commodities dealers or
investment or commodities trading advisors or counsel? ...................... Yes [
] No [ ]
B. had a license or registration as a securities or commodity dealer, broker,
investment advisor, salesperson, futures commission merchant, associated
person, commodity pooloperator or commodity trading advisor denied,
suspended, revoked, cancelled or refused? .......... Yes [ ] No [ ]
C. been enjoined or restrained by any court or government agency from:
1. the issuance, sale or offer for sale of securities or commodities?
.....Yes [ ] No [ ]
2. rendering securities or commodities advice or counsel? .. Yes [ ] No
[ ]
3. handling or managing trading accounts?.............................Yes [ ]
No [ ]
4. continuing any practices in connection with securities or
commodities?.
Yes [ ] No
[ ]
** Found on the fee receipt you received for your original filing.
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