FORM MA-I OMB APPROVAL OMB Number: 3235-0681 Expires: May 31, 2017 Estimated average burden hours per initial response. . . . . . . . . . . . 3.0 per amendment. . . . . . . . . . . . . . .0.5 INFORMATION REGARDING NATURAL PERSONS WHO ENGAGE IN MUNICIPAL ADVISORY ACTIVITIES Please read the General Instructions for this form and other forms in the MA series, as well as its subsection, "Specific Instructions for Form MA-I," before completing this form. All italicized terms herein are defined or described in the Glossary of Terms appended to the General Instructions. PART I This form must be completed by: · Every municipal advisory firm applying for registration or registered as a municipal advisor on Form MA, to provide information regarding each natural person who is an associated person of the firm and engages in municipal advisory activities on the firm's behalf (for purposes of Form MA-I, the "individual"); and · Every natural person (sole proprietor) applying for registration as a municipal advisor on Form MA, to provide additional personal information. WARNING: Complete this form truthfully. False statements or omissions may result in denial of a municipal advisor's application or revocation or suspension of such registration, administrative or civil action, or criminal prosecution. Form MA-I must be amended promptly whenever any information previously provided becomes inaccurate. See General Instruction 9. Type of Filing: This is an (check the appropriate box): Initial Form MA-I Execution Pages: Before submitting this form, you must complete the Execution Page. Supporting Documentation: If you are required to make reportable disclosures in the Disclosure Reporting Pages, you must attach the supporting documentation. Non-Resident Individuals: If the individual is a non-resident of the United States, you must attach a completed Form MA-NR signed by the individual to this Form MA-I at the time of the initial filing of Form MA-I See the General Instructions. Amendment to the most recent Form MA-I Amendment to indicate that the individual is no longer an associated person of the municipal advisory firm or no longer engages in municipal advisory activities on its behalf. (If you check this box, complete only Item 1-A and Item 7 below.) Item 1 Identifying Information Is this an amendment to change identifying information regarding the individual named in part A below? Yes SEC 2899 (4/14) No American LegalNet, Inc. www.FormsWorkFlow.com A. The Individual Full Legal Name: Enter all the letters of each name and not initials or other abbreviations. If no middle name, enter NMN on that line. ________________________ ________________ _______________ __________ Last Name First Name Middle Name Suffix Individual CRD No. (if any): _______________ Social Security No.: _________________ The Social Security Number will not be included in publicly available versions of this form. B. Municipal Advisory Firms Where the Individual Is Employed In providing your responses, please note that the definition of "employee" for purposes of this form includes an independent contractor who engages in municipal advisory activities on behalf of a municipal advisory firm. See Glossary of Terms. Is the individual employed at more than one municipal advisory firm? Yes No If the answer is "Yes," enter the number of municipal advisory firms the individual is employed with (sole proprietors not employed with any other firm enter 1): ____ (For individuals who are employed with more than one firm, provide the information required by this Item 1-B for each such firm. For sole proprietors, enter the legal name under which you conduct your municipal advisorrelated activities, and skip to Item 1-B.1.) Full Legal Name of municipal advisory firm with which the individual is employed: ____________________________________________________________________________ Name under which municipal advisor-related business is primarily conducted, if different from above: _________________________________________________________________________________ Date that the individual's most recent employment with this municipal advisory firm commenced (MM/DD/YYYY): __________ Does the individual have an independent contractor relationship with the above-named firm? (1) Municipal Advisory Firm's Registration Information: Is the municipal advisory firm currently registered on Form MA as a municipal advisor? (Answer "Yes" if you have already filed Form MA and your application for registration on that form has been approved. Otherwise, answer "No.") Yes No If "No," has the municipal advisory firm filed a Form MA application? Yes Form MA Filing Date: ______________ (MM/DD/YYYY) EDGAR CIK No.: ____________ SEC File No. _____________ Yes No 2 American LegalNet, Inc. www.FormsWorkFlow.com No If "No," please provide an explanation: ___________________________________________________________________________________ ___________________________________________________________________________________ (2) Office Enter the following information for each office of the municipal advisory firm where the individual is or will be physically located, and each office from which the individual is or will be supervised: Located At: Supervised From: Start Date: ____________ Street Address 1: ___________________________________________________________ Street Address 2: ___________________________________________________________ City: __________ State: ______ Country: ________________ Postal Code: ____________ If the office where the individual is or will be physically located is a private residence, check this box: A private residential address will not be included in publicly available versions of this form. Item 2 Other Names Enter the following information for all other names that the individual has used or is using, or by which the individual is known or has been known, other than the individual's legal name, since the age of 18. This space should include, for example, nicknames, aliases, and names used before or after marriage. Enter all the letters of each name and not initials or other abbreviations. If no middle name, enter NMN on that line. __________________________ _______________ _____________ __________ Last Name First Name Middle Name Suffix Item 3 Residential History Starting with the current address, enter the following information for all the individual's residential addresses for the past 5 years. Leave no gaps greater than three months between add