: : FIS 0505 (9/01) Index No. Calendar No. Office of Financial & Insurance Services : MICHIGAN BROKER-DEALER APPLICATION CHECKLIST/GENERAL JUDICIAL SUBPOENA Plaintiff(s) INFORMATION -against: Listed below are the instructions on how to apply for Broker-Dealer:registration pursuant to the Michigan Uniform Securities Act, 1964 PA 265, as amended, MCL 451.501 et seq.; MSA 19.776(101) et seq. Copies of : the Act, form and instructions are available by writing to the address listed below or on our Web site at http:// www.cis.state.mi.us/ofis/. Defendant(s) : ...................................................... IF YOUR BROKER-DEALER IS A MEMBER OF THE NATIONAL ASSOCIATION OF SECURITIES DEALERS, INC. (NASD): Notify Web CRD that the firm intends to apply for broker-dealer registration in Michigan by amending the firm's Form BD on CRD. The CRD will advise Michigan and remove the $250.00 THE PEOPLE fee from your account and forward Broker-dealer filing OF THE STATE OF NEW YORK it to Michigan. Then SUBMIT THE FOLLOWING DIRECTLY TO MICHIGAN for review: TO _____1. A Current Balance Sheet and Net Capital Computation or detailed Focus Report not older than 45 days. ____ GREETINGS:of the applicant’s most recent audited financial statement. If the applicant has never had 2. A copy audited financial statements prepared, please explain the reason in writing. (See Section 202(a)(5) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before of the Michigan Uniform Securities Act and Rule 603.4.) , the Honorable at the Court located at County of If the firm IS NOT A MEMBER OF THE NASD and will not be a member, submit all of the following in room , on the day of , 20 , at o'clock in the noon, and at any recessed directly to the State of Michigan for review: or adjourned date, to testify and give evidence as a witness in this action on the part of the A current Form BD originally signed, dated and notarized by both the applicant and the notary with item 2 completed for Michigan. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to ____ the party on whose behalf this subpoena was issuedto the maximum penalty of $50 and all damagesfee. 2. A cashier's check or money order payable for a State of Michigan for the $250.00 filing sustained as a result of your failure to comply. ____ 3. A copy of written supervisory procedures to be used by the proposed broker-dealer. _____1. Witness, Honorable , one of the Justices of the ____ Court A current balance sheet andday of 4. net capital computation not older than 45 days that has been certified in County, , 20 for correctness by an authorized person. ____ 5. A copy of the firm's most recvent audited financial statement. RETURN COMPLETED APPLICATION TO: First Class Mail Delivery Securities Unit P.O. Box 30220 Lansing, Michigan 48909 Overnight Delivery (Without Filing Fees) Securities Unit 611 West Ottawa, 2nd Floor Lansing, Michigan 48933 (Attorney must sign above and type name below) Attorney(s) for Overnight Delivery (With Filing Fees) Securities Unit 7150 Harris Drive Office and P.O. Address Lansing, Michigan 48909 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com Our Web address is http://cis.state.mi.us/ofis Our toll free phone number is 1-877-999-6442