Form SEC-2205 Form N-17f-1

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

FORM N-17f-1

OMB APPROVAL
OMB Number:
3235-0359
Expires:
June 30, 2009
Estimated average burden
hours per response. . . . . .2.00

Certificate of Accounting of Securities and Similar
Investments of a Management Investment Company
in the Custody of Members of
National Securities Exchanges
Pursuant to Rule 17f-1 [17 CFR 270.17f-1]
1. Investment Company Act File Number:

Date examination completed:

8112. State identification Number:
AL

AK

AZ

AR

CA

CO

CT

DE

DC

FL

GA

HI

ID

IL

IN

IA

KS

KY

LA

ME

MD

MA

MI

MN

MS

MO

MT

NE

NV

NH

NJ

NM

NY

NC

ND

OH

OK

OR

PA

RI

SC

SD

TN

TX

UT

VT

VA

WA

WV

WI

WY

PUERTO RICO

Other (specify):
3. Exact name of investment company as specified in registration statement:

4. Address of principal executive office (number, street, city, state, zip code):

I NSTRUCTIONS
This Form must be completed by investment companies that place or maintain securities or similar investments in the custody of a company that
is a member of a national securities exchange.
Investment Company
1.

All items must be completed by the investment company.

2.

Give this Form to the independent public accountant who, in compliance with Rule 17f-1 under the Act and applicable state law, examines
securities and similar investments in the custody of a company that is a member of a national securities exchange.

Accountant
3.

Submit this Form to the Securities and Exchange Commission and appropriate state securities administrators when filing the certificate of
accounting required by Rule 17f-1 under the Act and applicable state law. File the original and one copy with the Securities and Exchange
Commission’s principal office in Washington, D.C., one copy with the regional office for the region in which the investment company’s
principal business operations are conducted, and one copy with the appropriate state administrator(s), if applicable.
THIS FORM MUST BE GIVEN TO YOUR INDEPENDENT PUBLIC ACCOUNTANT

SEC 2205 (11-03)

SEC’s Collection of Information
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid
OMB control number. Filing of Form N-17f-1 is mandatory for an investment company that maintains securities or similar investments in the custody
of a member of a National Securities Exchange. Rule 17f-1 under section 17(f) of the Investment Company Act of 1940 requires the investment
company to retain an independent public accountant to verify the company’s securities and similar investments by actual examination three times
during each fiscal year. The accountant must prepare a certificate stating that the examination has occurred and describing the examination, and must
transmit the certificate to the Commission with Form N-17f-1 as a cover sheet. The Commission uses the Form to ensure that the certificate is properly
attributed to the investment company. The Commission estimates that the burden of completing Form N-17f-1 is approximately 0.16 hours per filing.
Any member of the public may direct to the Commission any comments concerning the accuracy of the burden estimate of this Form, and any
suggestions for reducing the burden of the Form. This collection of information has been reviewed by the Office of Management and Budget in
accordance with the clearance requirements of 44 U.S.C. § 3507. Responses to this collection of information will not be kept confidential.

2