Application For Temporary Or Continuing Hardship Exemption Form. This is a Missouri form and can be use in Blue Sky Secretary Of State.
Tags: Application For Temporary Or Continuing Hardship Exemption, SADVSH, Missouri Secretary Of State, Blue Sky
Robin Carnahan Secretary of State State of Missouri Securities Division • 600 W. Main • PO Box 1276 Jefferson City, MO 65102 Application for Temporary or Continuing Hardship Exemption Identifying Information Item 1 SEC File Number (if you have one): 801 - CRD Number (if you have one): A. Applicant's full legal name (if you are a sole proprietor, state your last, first and middle names): B. Principal Office and Place of Business Address (do not use a PO Box): (number and street) (city) (state) (county) (zip+4) If this address is a private residence, check this box: C. Name and telephone number of the individual filing this Form SADV-SH: (name) Item 2 (title) (area code + telephone number) Type of Exemption You are (check one): Requesting a Temporary Hardship Exemption; or Applying for a Continuing Hardship Exemption If you are requesting a temporary hardship exemption, this Form SADV-SH is for your (check one): Initial State Registration Amendment to State Registration (''other-than-annual'' on IARD) FORM SADV-SH (01-05) PAGE 1 American LegalNet, Inc. www.USCourtForms.com Item 3 A. Information Relating to the Hardship If you are filing to request a temporary hardship exemption, attach a separate page that: 1. Describes the nature, extent, burden and/or expense incurred to timely submit your filings in the electronic format. 2. Provides any other reasons why a temporary hardship exemption is warranted. B. If you are applying for a continuing hardship exemption, your application will be granted or denied based on the following items. You should attach a separate page that: 1. Describes the reason(s) that the necessary hardware and software are not available without unreasonable burden and expense. 2. Describes the burden and expense of employing alternative means (e.g. public library, service provider) to timely submit your filings in the electronic format. 3. Provides any other reasons why a continuing hardship exemption is warranted. Item 4 How to Submit your Form SADV-SH Sign this Form SADV-SH and mail the original to the Missouri Securities Division, 600 West Main, Jefferson City, MO 65101. You must preserve a copy of the Form SADV-SH for your records. Item 5 Execution I, the undersigned, have signed the Form SADV-SH on behalf of, and with the authority of, the adviser requesting a temporary hardship exemption or applying for a continuing hardship exemption. The undersigned and the adviser represent that the information and statements made in this SADV-SH, including any other information submitted, are true. The undersigned and the adviser further agree to waive any claim against the Commissioner for errors made in good faith that may occur when converting to electronic format this Form SADV-SH or any paper filing made in reliance on a continuing hardship exemption. Signature: Date: Printed Name: Title: FORM SADV-SH (01-05) PAGE 2 American LegalNet, Inc. www.USCourtForms.com