Form MA-T Form MA-T Form MA-T

OMB APPROVAL

OMB Number: ______

Expires: ______

Estimated average

Burden hours per form: ____

Note: Form MA-T is an electronic form accessible through a link located on the website of the U.S. Securities and Exchange Commission at www.sec.gov. It may not be filed in paper form.

FORM MA-T

MUNICIPAL ADVISOR TEMPORARY REGISTRATION FORM

ITEM 1 - IDENTIFYING INFORMATION

A. This is:

• An initial temporary registration as a municipal advisor

• An amendment of temporary registration as a municipal advisor

Municipal Advisor Registration Number: _ _ _ -_ _ _ _ _ _ _

• A withdrawal of temporary registration as a municipal advisor

Municipal Advisor Registration Number: _ _ _ -_ _ _ _ _ _ _

B. Full Legal Name of municipal advisor:

______________________________________________________________________

(firm name or name of sole proprietor)

C. Name under which the municipal advisor conducts business, if different:

______________________________________________________________________

D. IRS Employer Identification Number of the municipal advisor: ____________________

(Note: If you are a sole proprietor, leave this space blank. Do NOT fill in your social security number.)

E. If the municipal advisor is also registered with the SEC as an investment adviser, its SEC file number: 801-___________

F. If the municipal advisor is also registered with the SEC as a broker, dealer, or municipal securities dealer, its SEC file number: _______________________________

G. If the municipal advisor has a number (“CRD Number”) assigned by the FINRA’s CRD system or by the IARD system, its CRD number (Do not provide the CRD number of the municipal advisor’s officers, employees, or affiliates): ____________________________

H. Municipal advisor’s principal office and place of business:

(1) Address (do not use a P.O. Box):

__________________________________________________________________

(number and street)

__________________________________________________________________

(city) (state/country) (zip+4/postal code)

(2) Telephone number at this location: _____________________________________

(area code) (telephone number)

(3) Facsimile number at this location, if any: ____________________________________________

(area code) (telephone number)

(4) General e-mail address for the municipal advisor, if any: ______________@_____________

(5) Website, if any, of the municipal advisor

www.___________________ . ________

I. Mailing address, if different from the municipal advisor’s principal office and place of business address:

____________________________________________________________________

(number and street)

____________________________________________________________________

(city) (state/country) (zip+4/postal code)

J. Contact person: [The contact person should be a person whom the municipal advisor has authorized to receive information and respond to questions about this registration.]

________________________________________________________________________

(name)

________________________________________________________________________ (title)

__________________________________ ___________________________________

(telephone number, including area code) (facsimile number, if any, including area code)

___________________________________________________________________

(number and street)

____________________________________________________________________

(city) (state/country) (zip+4/postal code)

_____________________@____________________________

(e-mail address, if any, of contact person)

ITEM 2 - MUNICIPAL ADVISORY ACTIVITIES

What type(s) of municipal advisory services does the municipal advisor provide? Check all that apply.

 (1) Advice concerning the issuance of municipal securities

 (2) Advice concerning the investment of the proceeds of municipal securities

 (3) Advice concerning guaranteed investment contracts

 (4) Recommendation and/or brokerage of municipal escrow investments

 (5) Advice concerning the use of municipal derivatives (e.g., swaps)

 (6) Solicitation of business from a municipal entity or obligated person for an unaffiliated person or firm (e.g., third party marketers, placement agents, solicitors and finders)

 (7) Preparation of feasibility studies, tax or revenue projections, or similar products in connection with offerings or potential offerings of municipal securities

 (8) Other (specify):____________________________

ITEM 3 - DISCIPLINARY INFORMATION

In this Item, we ask for information about the municipal advisor’s disciplinary history and the disciplinary history of all associated municipal advisor professionals (as defined in the Glossary accompanying this form). For any question to which you answer “yes,” a drop-down box will appear for you to supply relevant information. Note: If you have submitted a Criminal Disclosure Report Page or Pages, a Regulatory Action Disclosure Page or Pages, or a Civil Judicial Action Disclosure Reporting Page or Pages to FINRA or the SEC in connection with other filings, you may provide such information by referencing the public disclosure system (BrokerCheck or Investment Adviser Public Disclosure) that currently contains the disclosure, the CRD number of the entity under which the disclosure is listed, and whether the entity under which the disclosure is listed is a firm or individual. (Example: Please reference BrokerCheck, CRD 123456, for the individual Mr. X for reportable disclosures; Example: Please reference IAPD, CRD 987654, for the firm X’s reportable disclosures.)

One event may result in “yes” answers to more than one of the questions below.

A. In the past ten years, has the municipal advisor or any associated municipal advisor professional:

(1) been convicted of or pled guilty or nolo contendere (“no contest”) in a

domestic, foreign, or military court to any felony? YES/NO

(2) been charged with any felony? YES/NO

You may limit your response to Item 3.A(2) to charges that are currently pending.

B. In the past ten years, has the municipal advisor or any associated municipal advisor professional:

(1) been convicted of or pled guilty or nolo contendere (“no contest”) in a domestic,

foreign, or military court to a misdemeanor involving: investments or an

investment-related business, or any fraud, false statements, or omissions,

wrongful taking of property, bribery, perjury, forgery, counterfeiting, extortion,

or a conspiracy to commit any of these offenses? YES/NO

(2) been charged with a misdemeanor listed in Item 3.B(1)? YES/NO

You may limit your response to Item 3.B(2) to charges that are currently pending.

C. Has the SEC or the Commodity Futures Trading Commission (CFTC) ever:

(1) found the municipal advisor or any associated municipal advisor professional to have made a false statement or omission? YES/NO

(2) found the municipal advisor or any associated municipal advisor professional to have been involved in a violation of its regulations or statutes? YES/NO

(3) found the municipal advisor or any associated municipal advisor professional to have been a cause of an investment-related business having its authorization to do business denied, suspended, revoked, or restricted? YES/NO

(4) entered an order against the municipal advisor or any associated municipal advisor professional in connection with investment-related activity? YES/NO

(5) imposed a civil money penalty on the municipal advisor or any associated municipal advisor professional, or ordered the municipal advisor or any associated municipal advisor professional to cease and desist from any activity? YES/NO

D. Has any other federal regulatory agency, any state regulatory agency, or any foreign financial regulatory authority:

(1) ever found the municipal advisor or any associated municipal advisor professional to have made a false statement or omission, or been dishonest, unfair, or unethical? YES/NO

(2) ever found the municipal advisor or any associated municipal advisor professional to have been involved in a violation of investment-related regulations or statutes? YES/NO

(3) ever found the municipal advisor or any associated municipal advisor professional to have been a cause of an investment-related business having its authorization to do business denied, suspended, revoked, or restricted? YES/NO

(4) in the past ten years, entered an order against the municipal advisor or any associated municipal advisor professional in connection with an investment-related activity? YES/NO

(5) ever denied, suspended, or revoked the municipal advisor’s or any associated municipal advisor professional’s registration or license, or otherwise prevented the municipal advisor or any associated municipal advisor professional, by order, from associating with an investment-related business or restricted the municipal advisor’s or any associated municipal advisor professional’s activity? YES/NO

E. Has any self-regulatory organization or commodities exchange:

(1) ever found the municipal advisor or any associated municipal advisor professional to have made a false statement or omission? YES/NO

(2) ever found the municipal advisor or any associated municipal advisor professional to have been involved in a violation of its rules (other than a violation designated as a “minor rule violation” under a plan approved by the SEC)? YES/NO

(3) ever found the municipal advisor or any associated municipal advisor professional to have been the cause of an investment-related business having its authorization to do business denied, suspended, revoked, or restricted? YES/NO

(4) ever disciplined the municipal advisor or any associated municipal advisor professional by expelling or suspending it from membership, barring or suspending its association with other members, or otherwise restricting its activities? YES/NO

F. Has the municipal advisor’s or any associated municipal advisor professional’s authorization to act as an attorney, accountant, or federal contractor ever been revoked or suspended? YES/NO

G. Is the municipal advisor or any associated municipal advisor professional the subject of any regulatory proceeding that could result in a “yes” answer to any part of Item 3.C., 3.D., or 3.E.? YES/NO

H. (1) Has any domestic or foreign court:

(a) in the past ten years, enjoined the municipal advisor or any associated municipal advisor professional in connection with any investment-related activity? YES/NO

(b) ever found that the municipal advisor or any associated municipal advisor professional was involved in a violation of investment-related statutes or regulations? YES/NO

(c) ever dismissed, pursuant to a settlement agreement, an investment-related

civil action brought against the municipal advisor or any associated municipal advisor professional by a state or foreign financial regulatory authority? YES/NO

(2) Is the municipal advisor or any associated municipal advisor professional now the subject of any civil proceeding that could result in a “yes” answer to any part of Item 3.H(1)? YES/NO

ITEM 4 – EXECUTION

The municipal advisor consents that service of any civil action brought by or notice of any proceeding before the Securities and Exchange Commission or any self-regulatory organization in connection with the municipal advisor’s municipal advisory activities may be given by registered or certified mail or confirmed telegram to the municipal advisor’s contact person at the main address, or mailing address, if different, given in Items 1.H, 1.I., and 1.J.

The undersigned deposes and says that he/she has executed this form on behalf of, and with the authority of, the municipal advisor. The undersigned and the municipal advisor represent that the information and statements contained herein and other information filed herewith, all of which are made a part hereof, are current, true and complete. The undersigned and the municipal advisor further represent that, if this is an amendment, to the extent that any information previously submitted is not amended such information is currently accurate and complete.

Date: _____________________

Full Legal Name of Municipal Advisor: ______________________________

By. ___________________________________________

(signature)

Title: ________________________________

Warning: Intentional misstatements or omissions of fact constitute Federal criminal violations. See, 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

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