COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : TRADE OR ASSUMED NAME NOTIFICATION (FORM DBA-1) INSTRUCTIONS JUDICIAL SUBPOENA Plaintiff(s) WHO MUST FILE? -against- : The Connecticut Uniform Securities Act Regulations require that, before any : Connecticut registered broker-dealer, investment adviser, agent or investment adviser agent (or any applicant for registration) may use a trade or assumed name, a notice on Form DBA-1 : must be filed with the Securities and Business Investments Division. A Form DBA-1 must be filed even if the registrant or applicant uses both the trade name and the name already on file Defendant(s) : . . . with. the department .in .conducting. its .business. . You.must .immediately report any material ... ............. . ......... .. ........ ... .... changes to Form DBA-1 to the department in writing. There is no fee for filing Form DBA-1 or amendments to the form. SUBSTITUTIONS STATE OF NEW YORK THE PEOPLE OF THE ALLOWED: Broker-dealer Applicants and Registrants: If you list all business names associated with your Connecticut activity on Section 1 of Schedule D of Form BD, you may omit Form DBA-1. TO Investment Adviser Applicants and Registrants: If you list all business names GREETINGS: associated with your Connecticut activity on Section 1.B of Schedule D of Form ADV, you may omit Form DBA-1. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Agents and Investment Adviser Agents:the , the Honorable at Since Form U-4 does not presently Court located or County of include information on tradeat assumed names, you should file Form DBA-1. in room , on the day of , 20 , at o'clock in the noon, and at any recessed COMPLETING testify DBA-1 or adjourned date, toFORM and give evidence as a witness in this action on the part of the 1. Trade or Assumed Name. Complete and file a Form DBA-1 for each trade or assumed name used in Connecticut. If the applicant or registrant will use more than one trade to assumed name, file a separate form for each name of court Your failure or comply with this subpoena is punishable as a contemptused. and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a 2. Address of principal place of business. result of your failure to comply. 3. Filing status Only check one box. If you are amending Form DBA-1, please highlight the changes. Witness, Honorable Court in County, day of , one of the Justices of the , 20 4. Identify the individual or entity using the trade or assumed name. If more than one individual or entity will use the name, complete a separate form for each user. 5. Provide the name and telephone number for the contact person filing this form. 6 Manually sign Form DBA-1 and return it to the Connecticut Securities and Business Investments Division. If you have questions about the form,for Attorney(s) please direct them to: (Attorney must sign above and type name below) State of Connecticut Department of Banking Securities and Business Investments Division 260 Constitution Plaza Hartford, CT 06103 Phone: (860) 240-8230. Rev. 1/2001 Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : TRADE OR ASSUMED NAME NOTIFICATION (FORM DBA-1) JUDICIAL SUBPOENA Plaintiff(s) 1 What is the trade or assumed name? __________________________________________ -against: 2. The principal place of business address for the person using the name is : ___________________________________________________________________________ : 3. Filing Status: ( ) Initial or first-time notice Defendant(s) : (. . . . ) . .Amendment . . . . . . . . changes only) ............................. . . . . . . . . . . . (highlight ( ) Termination notice (name no longer used) 4. The individual or entity using the Trade or Assumed Name is: THE PEOPLE OF THE STATE OF NEW YORK CRD number is ________________________ (if no ( ) A broker-dealer agent whose CRD number, supply Social Security Number) and who is registered with the following TO broker-dealer in Connecticut: ________________________________________________ ( GREETINGS: ) An investment adviser agent whose CRD number is___________________ (if no CRD number, supply Social Security Number) and who is registered with the following WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court investment adviser in Connecticut: ____________________________________________ located at County of in room ( on the day of , 20 , ___________________________________ recessed o'clock in the noon, and at any ) , A broker-dealer whose CRD number isat or adjourned date, to testify and give evidence as a witness in this action on the part of the ( 5. ) An investment adviser whose CRD number is _______ _________(if applicable). Name of individual or entity using the Trade or Assumed Name: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to If the trade or this subpoena was issued for a connection with of $50 conducted on sustained as a the 6. party on whose behalf assumed name will be used inmaximum penalty activity and all damagesthe premisesto comply. result of your failure of a financial institution, provide the institution’s name: ___________________________________________________________________ Witness, Honorable , one of the Justices of the 7. in Who may we contact about of filing? (include phone number): this Court County, day , 20 ___________________________________________________________________ (Attorney must sign above and type name below) The undersigned certifies, under penalty of false statement, that the information provided herein and in any supplements included herewith is true, accurate and complete, and acknowledges that any material changes to such information must be immediately reported to the Securities and Business Investments Division of the Attorney(s) for State of Connecticut Department of Banking. __________________________________________ Signature and Date Office and P.O. Address __________________________________________ Print name of person signing and provide title for business organizations other than proprietorships Rev. 1/2001 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com