Deferral Request Form-Agent
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Deferral Request Form-Agent Form. This is a Massachusetts form and can be use in Blue Sky Secretary Of State.
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Tags: Deferral Request Form-Agent, DFRRLA, Massachusetts Secretary Of State, Blue Sky
THE COMMONWEALTH OF MASSACHUSETTS SECRETARY OF THE COMMONWEALTH SECURITIES DIVISION ONE ASHBURTON PLACE BOSTON, MASSACHUSETTS 02108 DEFERRAL REQUEST FORMAGENT ______________________________________________________________ hereby am
ends Name of Fir m the application for registration of ____________________________________
_______________ Name of Age nt as an agent of _________________________________________________________
_________ N ame of Firm in Massachusetts and requests a deferral of the thirty-day time period set forth in M.G.L. c.110A, 202 for action by the Securities Division with respect to the application. The undersigned hereby certifies that he/she has the authority to amend the application and to make this request for a deferral on behalf of ____________________________
______________ N ame of Fir m ____________________ and on behalf of __________________________________
_________ N ame of Age nt and does so pursuant to that authority. _______________________________________ Signature _______________________________________ Print Name and Title _______________________________________ D a te American LegalNet, Inc. www.USCourtForms.com
