State Covered Investment Adviser Affidavit
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State Covered Investment Adviser Affidavit Form. This is a Missouri form and can be use in Blue Sky Secretary Of State.
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Tags: State Covered Investment Adviser Affidavit, SADV1, 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
State Covered Investment Adviser Affidavit
I,
, do hereby swear and affirm that I am a principal of
(“the applicant”) and I hereby make the following
representation on behalf of the applicant, after having thoroughly searched all applicable records that:
Designation of Chief Compliance Officer: The Chief Compliance Officer named below has applied for registration and meets the examination requirements specified in MO 15 CSR 30-51.030(2)(C) and will serve in the
capacity of Chief Compliance Officer for the applicant.
____________________________________________
Name
____________________________________________
CRD Number
(Mark only one of the three boxes below)
The applicant has never had any clients that reside in the State of Missouri.
The applicant has maintained accounts for the following clients (attach a list of names, addresses, and
telephone numbers of all Missouri clients, as well as the date each account was opened):
The applicant has been registered as an investment adviser with the Securities and Exchange Commission
and has been conducting business in Missouri as a federal covered adviser. Applicant became ineligible
for federal registration on
and will not conduct advisory business in Missouri
until it has received registration as a state covered adviser.
(Principal’s Signature)
Subscribed and sworn to before me this
day of
20
(Notary Public)
My Commission expires:
FORM SADV-1 (03-11)
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