Form MA-I Form MA-I

FORM MA-I
APPLICATION FOR MUNICIPAL ADVISOR REGISTRATION FOR NATURAL
PERSONS
PART 1
This form must be completed by all municipal advisors who are natural persons, including employees of municipal
advisors that are organized entities (referred to herein as “municipal advisory firms”) and sole proprietors (together,
“natural person municipal advisors”). A municipal advisory firm applying for registration as a municipal advisor
must complete Form MA. A sole proprietor must complete both Form MA and this Form MA-I.
WARNING:

Complete this form truthfully. False statements or omissions may result in denial of
application, revocation of registration, or criminal prosecution. Form MA-I must be amended
whenever any information previously provided becomes inaccurate. See General Instruction
9. All italicized terms are defined or described in the Glossary to this Form.

Check the appropriate box:
This is an:
 Initial application to register as a municipal advisor with the SEC.
 Amendment to the municipal advisor’s most recent Form MA-I.
 Municipal advisor’s annual self-certification.
Item 1 Identifying Information
Note: If this is an amendment to change identifying information regarding the applicant in part A below, check this
box 
A. The Applicant
Full Legal Name:
First: __________ Middle: __________ Last: _______________ Suffix: ___
Individual CRD No.: _______________ SSN: _______________
B. The Applicant’s Municipal Advisory Firm
Name of municipal advisory firm with which applicant is employed:
______________________________________________________________________________
Most recent date employment with this municipal advisory firm commenced (MM/DD/YYYY): _______________
Does the applicant have an independent contractor relationship with the above-named firm?  Yes  No
Municipal Advisory Firm’s Registration Information:
Check all that apply:

 Municipal Advisor

SEC File No.: _______________

 Municipal Securities Dealer

SEC File No.: ______________

 Broker-Dealer

SEC File No.: _________________

CRD No.: _______________

SEC File No.: ___________
CRD No. _______________

CRD No.: ______________

 Investment Adviser



SEC-Registered
State Registered

 Government Securities Broker-Dealer SEC File No.: _______________ Bank Identifier ___________

 Other SEC Registration (Specify) ______________________

SEC File No. or CIK: ______

Enter the following information for each office of the municipal advisory firm where the natural person municipal
advisor will be physically located, and supervised from, as applicable:
Office
 Located At
 Supervised From
Start Date: _______________ End Date: _______________
Street Address 1: _______________________________________________________________
Street Address 2: _______________________________________________________________
City: _____________ State: _____ Country: _______________ Postal Code: _______________
Private Residence Check Box: If the Office of Employment address is a private residence, check this box. 
Item 2 Other Names
Enter the following information for all other names that you have used or are using, or by which you are known or
have been known, other than your legal name, since the age of 18. This space should include, for example,
nicknames, aliases, and names used before or after marriage.
First Name: __________ Middle Name: __________ Last Name: _______________ Suffix: ___
Item 3 Residential History
Starting with the current address, enter the following information for all residential addresses for the past 5 years.
Leave no gaps greater than three months between addresses. Report changes in an amendment as they occur.
Current Address:
From (MM/YYYY): _______________ To (MM/YYYY): _______________
Street Address 1: _______________________________________________________________
Street Address 2: _______________________________________________________________
City: _____________ State: _____ Country: _______________ Postal Code: _______________
Prior Address:
From (MM/YYYY): _______________ To (MM/YYYY): _______________
Street Address 1: _______________________________________________________________
Street Address 2: _______________________________________________________________
City: _____________ State: _____ Country: _______________ Postal Code: _______________
Item 4 Employment History
Provide complete employment history for the past 10 years. Include the municipal advisory firm noted in Item 1.
Enter the following information for each employer. Account for all time, leaving no gaps longer than three months,
including full and part-time employment, self-employment, military service, and homemaking. Also include statuses
such as unemployed, full-time education, extended travel, or other similar statuses.
Report changes in an amendment as they occur.
Current Employer:
From (MM/YYYY): _______________ To (MM/YYYY): _______________
Name of Municipal Advisory Firm or Company:
______________________________________________________________________
City: _______________ State: _______________ Country: _______________
Municipal Advisor-Related Business?  Yes  No
Investment-Related Business?  Yes  No
Position Held: ___________________________________________________________________________

2

Prior to the Above:
From (MM/YYYY): _______________ To (MM/YYYY): _______________
Name of Municipal Advisory Firm or Company:
______________________________________________________________________
City: _______________ State: _______________ Country: _______________
Municipal Advisor-Related Business?  Yes  No
Investment-Related Business?  Yes  No
Position Held: ___________________________________________________________________________
Item 5 Other Business
Are you currently engaged in any other business either as a proprietor, partner, officer, director, employee, trustee,
agent or otherwise?
 Yes  No
If yes, please enter the following details for each other business below:
Other Business:
Start Date (MM/YYYY): _______________
Name of Business: ______________________________________________________________________
Street Address 1: _______________________________________________________________
Street Address 2: _______________________________________________________________
City: _______________ State: _______________ Country: _______________
Municipal Advisor-Related Business?  Yes  No
Investment-Related Business?  Yes  No
Nature of Business: ______________________________________________________________
Position/Title/Relationship: _______________________________
Approximate No. of Hours / Month: _____________
Description of Duties:
Item 6 Disclosure Questions
IF THE ANSWER TO ANY OF THE FOLLOWING QUESTIONS IS “YES,” COMPLETE DETAILS OF ALL
EVENTS OR PROCEEDINGS ON THE APPROPRIATE DISCLOSURE REPORTING PAGES IN PART II.
Refer to the Glossary for definitions or descriptions of italicized terms.
YES

NO

(a) been convicted of or pled guilty or nolo contendere (“no contest”) in a domestic, foreign,
or military court to any felony?





(b) been charged with any felony?





(a) been convicted of or pled guilty or nolo contendere (“no contest”) in a domestic or foreign
court to any felony?





(b) been charged with any felony?





CRIMINAL ACTION DISCLOSURE
Item 6A.
(1) Have you ever:

(2) Based upon activities that occurred while you exercised control over it, has an organization ever:

Item 6B.
(1) Have you ever:

3

(a) been convicted of or pled guilty or nolo contendere (“no contest”) in a domestic, foreign or
military court to a misdemeanor involving: municipal advisory activities or a municipal
advisor-related or 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?





(b) been charged with a misdemeanor specified in 6B(1)(a)?





(a) been convicted of or pled guilty or nolo contendere (“no contest”) in a domestic or foreign
court to a misdemeanor specified in 6B(1)(a)?





(b) been charged with a misdemeanor specified in 6B(1)(a)?





YES

NO

(2) Based upon activities that occurred while you exercised control over it, has an organization ever:

REGULATORY ACTION DISCLOSURE

Item 6C.
Has the U.S. Securities and Exchange Commission or the Commodity Futures Trading Commission ever:
(1) found you to have made a false statement or omission?





(2) found you to have been involved in a violation of its regulations or statutes?





(3) found you to have been the cause of a denial, suspension, revocation, or restriction of the
authorization of a municipal advisor-related business or investment-related business to
operate?





(4) entered an order against you in connection with municipal advisor-related or investmentrelated activity?





(5) imposed a civil money penalty on you, or ordered you to cease and desist from any
activity?





(6) found you to have willfully violated any provision of the Securities Act of 1933, the
Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment
Company Act of 1940, the Commodity Exchange Act, or any rule or regulation under any
of such Acts, or any of the rules of the Municipal Securities Rulemaking Board, or found
you to have been unable to comply with any provision of such Act, rule or regulation?





(7) found you to have willfully aided, abetted, counseled, commanded, induced, or procured
the violation by any person of any provision of the Securities Act of 1933, the Securities
Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act
of 1940, the Commodity Exchange Act, or any rule or regulation under any of such Acts,
or any of the rules of the Municipal Securities Rulemaking Board?





(8) found you to have failed reasonably to supervise another person subject to your
supervision, with a view to preventing the violation of any provision of the Securities Act
of 1933, the Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the
Investment Company Act of 1940, the Commodity Exchange Act, or any rule or regulation
under any of such Acts, or any of the rules of the Municipal Securities Rulemaking Board?





Item 6D.
(1) Has any other federal regulatory agency or any state regulatory agency or foreign financial regulatory authority
ever:

4

(a) found you to have made a false statement or omission or been dishonest, unfair or
unethical?





(b) found you to have been involved in a violation of municipal advisor-related or investmentrelated regulation(s) or statute(s)?





(c) found you to have been a cause of the denial, suspension, revocation, or restriction of the
authorization of a municipal advisor-related or investment-related business to operate?





(d) entered an order against you in connection with a municipal advisor-related or investmentrelated activity?





(e) denied, suspended, or revoked your registration or license or otherwise, by order,
prevented you from associating with a municipal advisor-related or investment-related
business or restricted your activities?





(2) Have you been subject to any final order of a state securities commission (or any agency or office performing
like functions), state authority that supervises or examines banks, savings associations, or credit unions, state
insurance commission (or any agency or office performing like functions), an appropriate federal banking
agency, or the National Credit Union Administration, that:
(a) bars you from association with an entity regulated by such commission, authority, agency,
or officer, or from engaging in the business of securities, insurance, banking, savings
association activities, or credit union activities; or





(b) constitutes a final order based on violations of any laws or regulations that prohibit
fraudulent, manipulative, or deceptive conduct?





(1) found you to have made a false statement or omission?





(2) found you 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 U.S. Securities and
Exchange Commission)?





(3) found you to have been the cause of a denial, suspension, revocation, or restriction of the
authorization of a municipal advisor-related or investment-related business to operate?





(4) disciplined you by expelling or suspending you from membership, barring or suspending
your association with its members, or restricting your activities?





(5) found you to have willfully violated any provision of the Securities Act of 1933, the
Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment
Company Act of 1940, the Commodity Exchange Act, or any rule or regulation under any
of such Acts, or any of the rules of the Municipal Securities Rulemaking Board, or found
you to have been unable to comply with any provision of such Act, rule or regulation?





(6) found you to have willfully aided, abetted, counseled, commanded, induced, or procured
the violation by any person of any provision of the Securities Act of 1933, the Securities
Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act
of 1940, the Commodity Exchange Act, or any rule or regulation under any of such Acts,
or any of the rules of the Municipal Securities Rulemaking Board?





6E.
Has any self-regulatory organization ever:

5









(1) regulatory complaint or proceeding that could result in a “yes” answer to any part of 6C, D
or E? (If “yes,” complete the Regulatory Action Disclosure Reporting Page.)





(2) investigation that could result in a “yes” answer to any part of 6A, B, C, D or E? (If “yes,”
complete the Investigation Disclosure Reporting Page.)





YES

NO

(a) enjoined you in connection with any municipal advisor-related or investment-related
activity?





(b) found that you were involved in a violation of any municipal advisor-related or
investment-related statute(s) or regulation(s)?





(c) dismissed, pursuant to a settlement agreement, a municipal advisor-related or investmentrelated civil action brought against you by a state or foreign financial regulatory
authority?





(2) Are you named in any pending municipal advisor-related or investment-related civil
action that could result in a “yes” answer to any part of 6H(1)?





CUSTOMER COMPLAINT/ARBITRATION/CIVIL LITIGATION DISCLOSURE

YES

NO

(7) found you to have failed reasonably to supervise another person subject to your
supervision, with a view to preventing the violation of any provision of the Securities Act
of 1933, the Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the
Investment Company Act of 1940, the Commodity Exchange Act, or any rule or regulation
under any of such Acts, or any of the rules of the Municipal Securities Rulemaking Board?
6F.
Have you ever had an authorization to act as an attorney, accountant or federal contractor that
was revoked or suspended?
6G.
Have you been notified, in writing, that you are now the subject of any:

CIVIL JUDICIAL ACTION DISCLOSURE
6H.
(1) Has any domestic or foreign court ever:

6I.
(1) Have you ever been the subject of a municipal advisor-related or investment-related, consumer-initiated
(written or oral) complaint which alleged that you were involved in fraud, false statements, omissions, theft,
embezzlement, wrongful taking of property, bribery, forgery, counterfeiting, extortion, and dishonest, unfair or
unethical practices, and which:
(a) is still pending, or;





(b) was settled?





(2) Have you ever been the subject of a municipal advisor-related or investment-related, consumer-initiated
arbitration or civil litigation which alleged that you were involved in fraud, false statements, omissions, theft,
embezzlement, wrongful taking of property, bribery, forgery, counterfeiting, extortion, and dishonest, unfair or
unethical practices, and which:


(a) is still pending, or;

6



(b) resulted in an arbitration award or civil judgment against you, regardless of amount, or;





(c) was settled?





YES

NO

TERMINATION DISCLOSURE

6J. Have you ever voluntarily resigned, been discharged or permitted to resign after allegations were made that
accused you of:
(1) violating municipal advisor-related or investment-related statutes, regulations, rules, or
industry standards of conduct?





(2) fraud or the wrongful taking of property?





(3) failure to supervise in connection with municipal advisor-related or investment-related
statutes, regulations, rules or industry standards of conduct?





YES

NO

(1) have you made a compromise with creditors, filed a bankruptcy petition or been the
subject of an involuntary bankruptcy petition?





(2) based upon events that occurred while you exercised control over it, has an organization
made a compromise with creditors, filed a bankruptcy petition or been the subject of an
involuntary bankruptcy petition?





(3) based upon events that occurred while you exercised control over it, has a broker or dealer
been the subject of an involuntary bankruptcy petition, or had a trustee appointed, or had a
direct payment procedure initiated under the Securities Investor Protection Act?





6L.
Has a bonding company ever denied, paid out on, or revoked a bond for you?









FINANCIAL DISCLOSURE
6K.
Within the past 10 years:

6M.
Do you have any unsatisfied judgments or liens against you?

7

Item 7 Signature and Self-Certification
Signature
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 address given in Item 1. To the extent that the municipal advisor is a non-resident municipal advisor, the
municipal advisor must also complete Form MA-NR.
I, the undersigned, certify, under penalty of perjury under the laws of the United States of America, that the
information and statements made in this Form MA-I, including exhibits and any other information submitted, are true
and correct, and that I am signing this Form MA-I Execution Page as a free and voluntary act.

Date: _____________________
Full Legal Name of Municipal Advisor: ______________________________
By: ___________________________________________
(signature)
Title: ________________________________

Self-Certification
I, the undersigned, certify that:
I have 1) sufficient qualifications, training, experience, and competence to effectively carry out my designated
functions; 2) met, or within any applicable required timeframes will meet, such standards of training, experience, and
competence, and such other qualifications, including testing, for a municipal advisor, required by the Commission,
the MSRB or any other relevant self-regulatory organization; and 3) the necessary understanding of, and ability to
comply with, all applicable regulatory obligations. For these purposes, such applicable regulatory obligations are
obligations under the federal securities laws and rules promulgated thereunder and applicable rules promulgated by
the MSRB, or any other relevant self-regulatory organization.
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).

8

PART 2: DISCLOSURE REPORTING PAGES (DRPs)
CRIMINAL ACTION DISCLOSURE
This Disclosure Form is an  INITIAL or  AMENDED response to report details for affirmative response(s) to
Question(s) 6A and 6B on Form MA-I;
Check the question(s) you are responding to, regardless of whether you are answering the question(s) “yes” or
amending the answer(s) to “no”:
6A(1)(a)
6A(1)(b)
6A(2)(a)
6A(2)(b)
6B(1)(a)
6B(1)(b)
6B(2)(a)
6B(2)(b)
Use this Disclosure Form to report all charges arising out of the same event. One event may result in more than one
affirmative answer to the above items. Multiple counts of the same charge arising out of the same event should be
reported on the same Disclosure Form. Unrelated criminal actions, including separate cases arising out of the same
event, must be reported on separate Disclosure Forms.
Applicable court documents (i.e., criminal complaint, information or indictment as well as judgment of conviction or
sentencing documents) must be provided electronically if not previously submitted.
If the applicant is also registered through the IARD system or CRD system, registered with the SEC as a municipal
advisor on Form MA, or previously registered with the SEC on Form MA-T, or is an associated person of a
municipal advisor that is registered with the SEC on Form MA or that previously registered with the SEC on Form
MA-T, has the applicant or municipal advisor with which it is associated previously submitted a DRP (with Form
ADV, BD, or U4) to the IARD or CRD, or submitted to the SEC disclosure on Form MA-T or a DRP with a Form
MA, for the event that contains the information required by this DRP?  Yes
 No
If the answer is “Yes,” no other information on this DRP must be provided.
NOTE: The completion of this form does not relieve the applicant or any municipal advisor with which it is
associated of its obligation to update its Form MA or its IARD or CRD records.
1. If charge(s) were brought against an organization over which you exercise(d) control:
A. Organization Name:___________________________________________
B. Municipal Advisor-Related or Investment-Related business?
 Yes  No
C. Position, title or relationship:___________________________________________
2. Formal action was brought in:
 Federal Court
 State Court
 Foreign Court
 Military Court
 Other: ______________________
A. Name of Court:____________________________________________________________________
B. Location of Court (City or County and State or Country):_____________________________________________
C. Docket/Case#:______________
3. Event Status:
A. Current status of the Event?  Pending
 On Appeal
 Final
B. Event Status Date (complete unless status is pending) (MM/DD/YYYY):_________
If not exact, provide explanation:

 Exact  Explanation

4. Event and Disposition Disclosure Detail (Use this for both organizational and individual charges.):
A. Date First Charged (MM/DD/YYYY):_________________
 Exact  Explanation
If not exact, provide explanation:
9

CRIMINAL ACTION DISCLOSURE (CONT.)
B. Event and Disposition Detail:
Charge Details (complete every space for each charge)
Formal Charge/Description:
No. of Counts: _________________
Felony or Misdemeanor:  Felony  Misdemeanor
Plea for each Charge: ___________________________________________________________
Disposition of Charge:
 Acquitted
 Amended
 Convicted
 Deferred Adjudication
Explanation:

 Dismissed
 Found not guilty
 Pled guilty
 Pled not guilty

 Pre-trial intervention
 Reduced
 Other (requires explanation)

Date of Amended Charge, if applicable: ___________________________________________________________
If original charge was amended or reduced, specify new charge (i.e., list amended charge or reduced charge):
No. of Counts (for amended or reduced charge): _________________
Specify if amended or reduced charge is a Felony or Misdemeanor:
 Felony  Misdemeanor
Plea for each amended or reduced Charge: __________________________________________________________
Disposition of amended or reduced Charge:
 Acquitted
 Dismissed
 Amended
 Found not guilty
 Convicted
 Pled guilty
 Deferred Adjudication
 Pled not guilty
Explanation:

 Pre-trial intervention
 Reduced
 Other (requires explanation)

Charge Details (complete every space for each charge)
Formal Charge/Description:
No. of Counts: _________________
Felony or Misdemeanor:  Felony  Misdemeanor
Plea for each Charge: ___________________________________________________________
Disposition of Charge:
 Acquitted
 Amended
 Convicted
 Deferred Adjudication
Explanation:

 Dismissed
 Found not guilty
 Pled guilty
 Pled not guilty

 Pre-trial intervention
 Reduced
 Other (requires explanation)

Date of Amended Charge, if applicable: ___________________________________________________________
If original charge was amended or reduced, specify new charge (i.e., list amended charge or reduced charge):
No. of Counts (for amended or reduced charge): _________________
Specify if amended or reduced charge is a Felony or Misdemeanor:
 Felony  Misdemeanor
Plea for each amended or reduced Charge: __________________________________________________________
10

CRIMINAL ACTION DISCLOSURE (CONT.)
Disposition of amended or reduced Charge:
 Acquitted
 Dismissed
 Amended
 Found not guilty
 Convicted
 Pled guilty
 Deferred Adjudication
 Pled not guilty
Explanation:

 Pre-trial intervention
 Reduced
 Other (requires explanation)

Charge Details (complete every space for each charge)
Formal Charge/Description:
No. of Counts: _________________
Felony or Misdemeanor:  Felony  Misdemeanor
Plea for each Charge: ___________________________________________________________
Disposition of Charge:
 Acquitted
 Amended
 Convicted
 Deferred Adjudication
Explanation:

 Dismissed
 Found not guilty
 Pled guilty
 Pled not guilty

 Pre-trial intervention
 Reduced
 Other (requires explanation)

Date of Amended Charge, if applicable: ___________________________________________________________
If original charge was amended or reduced, specify new charge (i.e., list amended charge or reduced charge):
No. of Counts (for amended or reduced charge): _________________
Specify if amended or reduced charge is a Felony or Misdemeanor:
 Felony  Misdemeanor
Plea for each amended or reduced Charge: __________________________________________________________
Disposition of amended or reduced Charge:
 Acquitted
 Dismissed
 Amended
 Found not guilty
 Convicted
 Pled guilty
 Deferred Adjudication
 Pled not guilty
Explanation:

C. Date of Disposition (MM/DD/YYYY):_________________
If not exact, provide explanation:

 Pre-trial intervention
 Reduced
 Other (requires explanation)

 Exact  Explanation

D. Sentence/Penalty; Duration (if suspension, probation, etc): Start Date of Penalty: (MM/DD/YYYY); End date of
Penalty: (MM/DD/YYYY); If Monetary penalty/fine - Amount paid; Date monetary/penalty fine paid:
(MM/DD/YYYY) if not exact, provide explanation.

5. Comment (Optional). You may use this space to provide a brief summary of the circumstances leading to the
charge(s) as well as the current status or final disposition. Your information must fit within the space provided.

11

REGULATORY ACTION DISCLOSURE
INITIAL
AMENDED response to report details for affirmative response(s) to
Question(s) 6C, 6D, 6E, 6F and 6G(1) on Form MA-I;
Check the question(s) you are responding to, regardless of whether you are answering the question(s) “yes” or
amending the answer(s) to “no”:
6C(1)
6D(1)(a)
6E(1)
6F
6C(2)
6D(1)(b)
6E(2)
6C(3)
6D(1)(c)
6E(3)
6G(1)
6C(4)
6D(1)(d)
6E(4)
6C(5)
6D(1)(e)
6E(5)
6C(6)
6D(2)(a)
6E(6)
6C(7)
6D(2)(b)
6E(7)
6C(8)
One matter may result in more than one affirmative answer to the above items. Use a single Disclosure Form to
report details to the same event. If an event gives rise to actions by more than one regulator, provide details to each
action on a separate Disclosure Form.
If the applicant is also registered through the IARD system or CRD system, registered with the SEC as a municipal
advisor on Form MA, or previously registered with the SEC on Form MA-T, or is an associated person of a
municipal advisor that is registered with the SEC on Form MA or that previously registered with the SEC on Form
MA-T, has the applicant or municipal advisor with which it is associated previously submitted a DRP (with Form
ADV, BD, or U4) to the IARD or CRD, or submitted to the SEC disclosure on Form MA-T or a DRP with a Form
MA, for the event that contains the information required by this DRP?  Yes
 No
If the answer is “Yes,” no other information on this DRP must be provided.
NOTE: The completion of this form does not relieve the applicant or any municipal advisor with which it is
associated of its obligation to update its Form MA or its IARD or CRD records.
1. Regulatory Action initiated by:
A. (Select appropriate item):
 SEC
 Other Federal
Agency

 Jurisdiction

 SRO

 CFTC

 Foreign
Financial
Regulatory
Authority

 Federal
Banking Agency

 National
 Other:__________________________
Credit Union
Administration
B. Full name of regulator (if other than the SEC) that initiated the action:__________________________________
2. Sanctions Sought (select all that apply):

Penalty(ies)/Fines(s)

on

3. Date Initiated (MM/DD/YYYY):_______________________________  Exact  Explanation
If not exact, provide explanation:
4. Docket/Case#:_______________________________
5. Employing Municipal Advisory Firm when activity occurred which led to the regulatory
action:_______________________________
12

REGULATORY ACTION DISCLOSURE (CONT.)
6. Product Type(s): (select all that apply)
-Charitable

tment-DPP & LP
Interest

-Fixed
-Variable
Preferred Stock)
-OTC
ity
-Financial
-Asset Backed
-Corporate
-Government
-Municipal
7. Describe the allegations related to this regulatory action:

8. Current Status?

 Pending

 On Appeal

 Final

9. If pending, are there any limitations or restrictions currently in effect?
If the answer is “yes,” provide details:

10. If on appeal:
A. Action appealed to:
 SEC
 SRO

 CFTC

 Federal Court

 Yes  No

 State Agency
or Commission

 State Court

 Other:_________________________________
B. Date appeal filed (MM/DD/YYYY):_______________________________  Exact  Explanation
If not exact, provide explanation:

C. Are there any limitations or restrictions currently in effect while on appeal?
If the answer is “yes,” provide details:

 Yes  No

If Final or On Appeal, complete all items below. For Pending Actions, complete Item 14 only.
11. Resolution Detail:
A. How was matter resolved? (select appropriate item):
Acceptance Waiver & Consent (AWC)
Decision & Order of Offer of Settlement
Settled
Vacated Nunc Pro Tunc / ab initio

Consent
Dismissed
Stipulation and Consent
Withdrawn

B. Resolution Date (MM/DD/YYYY):_______________________________
If not exact, provide explanation:

13

Decision
Order
Vacated

 Exact  Explanation

REGULATORY ACTION DISCLOSURE (CONT.)
12. Does the order constitute a final order based on violations of any laws or regulations that prohibit fraudulent, or
deceptive conduct?
 Yes  No
13. Sanction Detail:
A. Were any of the following sanctions ordered? (Select all appropriate items):
)
Penalty(ies)/Fine(s)

B. Other sanctions ordered:_______________________________
C. If suspended or barred, provide:
Sanction Type:

 Bar (Permanent)

 Bar (Temporary / Time Limited)  Suspension

Registration Capacities affected (e.g., General Securities Principal, Financial Operations Principal, All Capacities,
etc.):

Duration (length of time):__________________________________
If not exact, provide explanation:

 Exact  Explanation

Start Date (MM/DD/YYYY):_______________________________
If not exact, provide explanation:

 Exact  Explanation

End Date (MM/DD/YYYY):_______________________________
If not exact, provide explanation:

 Exact  Explanation

Sanction Details
Sanction Type:

 Bar (Permanent)

 Bar (Temporary / Time Limited)  Suspension

Registration Capacities affected (e.g., General Securities Principal, Financial Operations Principal, All Capacities,
etc.):

Duration (length of time):__________________________________
If not exact, provide explanation:

 Exact  Explanation

Start Date (MM/DD/YYYY):_______________________________
If not exact, provide explanation:

 Exact  Explanation

End Date (MM/DD/YYYY):_______________________________
If not exact, provide explanation:

 Exact  Explanation

14

REGULATORY ACTION DISCLOSURE (CONT.)
Sanction Details
Sanction Type:

 Bar (Permanent)

 Bar (Temporary / Time Limited)  Suspension

Registration Capacities affected (e.g., General Securities Principal, Financial Operations Principal, All Capacities,
etc.):

B. Duration (length of time):_______________________________
If not exact, provide explanation:

 Exact  Explanation

Start Date (MM/DD/YYYY):_______________________________
If not exact, provide explanation:

 Exact  Explanation

End Date (MM/DD/YYYY):_______________________________
If not exact, provide explanation:

 Exact  Explanation

D. If requalification by exam/retraining was a condition of the sanction, provide:
Requalification Details
Requalification Type:
 Requalification by Exam
 Re-Training
Length of time given to requalify/retrain:__________________
Type of Exam required:___________________________________________
Has condition been satisfied?  Yes  No
Explanation:

 Other

Requalification Details
Requalification Type:
 Requalification by Exam
 Re-Training
Length of time given to requalify/retrain:__________________
Type of Exam required:___________________________________________
Has condition been satisfied?  Yes  No
Explanation:

 Other

Requalification Details
Requalification Type:
 Requalification by Exam
 Re-Training
Length of time given to requalify/retrain:__________________
Type of Exam required:___________________________________________
Has condition been satisfied?  Yes  No
Explanation:

15

 Other

REGULATORY ACTION DISCLOSURE (CONT.)
E. If disposition resulted in a fine, penalty, restitution, disgorgement or monetary compensation, provide:
Monetary Sanction Details
Monetary Related Sanction Type:  Civil and Administrative Penalty(ies)/Fine(s)
 Monetary Penalty other than Fines
Total Amount: $_________________
Portion levied against you: $_________________
Payment Plan:
Is Payment Plan Current?  Yes  No
Date Paid by You (MM/DD/YYYY):_________________
If not exact, provide explanation:

 Disgorgement
 Restitution

 Exact  Explanation

Was any portion of penalty waived?
 Yes  No
If yes, amount: $_________________
Monetary Sanction Details
Monetary Related Sanction Type:  Civil and Administrative Penalty(ies)/Fine(s)
 Monetary Penalty other than Fines
Total Amount: $_________________
Portion levied against you: $_________________
Payment Plan:
Is Payment Plan Current?  Yes  No
Date Paid by You (MM/DD/YYYY):_________________
If not exact, provide explanation:

 Disgorgement
 Restitution

 Exact  Explanation

Was any portion of penalty waived?
 Yes  No
If yes, amount: $_________________
Monetary Sanction Details
Monetary Related Sanction Type:  Civil and Administrative Penalty(ies)/Fine(s)
 Monetary Penalty other than Fines
Total Amount: $_________________
Portion levied against you: $_________________
Payment Plan:
Is Payment Plan Current?  Yes  No
Date Paid by You (MM/DD/YYYY):_________________
If not exact, provide explanation:

 Disgorgement
 Restitution

 Exact  Explanation

Was any portion of penalty waived?
 Yes  No
If yes, amount: $_________________
14. Comment (Optional). You may use this space to provide a brief summary of the circumstances leading to the
action as well as the current status or disposition and/or finding(s).

16

INVESTIGATION DISCLOSURE
This Disclosure Form is an  INITIAL or  AMENDED response to report details for affirmative response(s) to
Question(s) 6G(2) on Form MA-I;
Check the question(s) you are responding to, regardless of whether you are answering the question(s) “yes” or
amending the answer(s) to “no”:
 6G(2)
Complete this Disclosure Form only if you are answering “yes” to Item 6G(2). If you answered “yes” to Item 6G(1),
complete the Regulatory Action Disclosure Form. If you have been notified that the investigation has been
concluded without formal action, complete items 4 and 5 of this Disclosure Form to update. One event may result in
more than one investigation. If more than one authority is investigating you, use a separate Disclosure Form to
provide details.
If the applicant is also registered through the IARD system or CRD system, registered with the SEC as a municipal
advisor on Form MA, or previously registered with the SEC on Form MA-T, or is an associated person of a
municipal advisor that is registered with the SEC on Form MA or that previously registered with the SEC on Form
MA-T, has the applicant or municipal advisor with which it is associated previously submitted a DRP (with Form
ADV, BD, or U4) to the IARD or CRD, or submitted to the SEC disclosure on Form MA-T or a DRP with a Form
MA, for the event that contains the information required by this DRP?  Yes
 No
If the answer is “Yes,” no other information on this DRP must be provided.
NOTE: The completion of this form does not relieve the applicant or any municipal advisor with which it is
associated of its obligation to update its Form MA or its IARD or CRD records.
1. Investigation initiated by:
A. Notice Received From (select appropriate item):
 SRO
 Foreign
 Jurisdiction
 SEC
 Other Federal
Financial
Agency
Regulatory Authority
 Other:_________________________________
B. Full name of regulator (if other than the SEC) that initiated the investigation:____________________________
2. Notice Date (MM/DD/YYYY):______________________________  Exact  Explanation
If not exact, provide explanation:

3. Describe briefly the nature of the investigation, if known:

4. Is investigation pending?
 Yes  No
If no, complete item 5. If yes, skip to item 6.
5. Resolution Details:
A. Date Closed/Resolved (MM/DD/YYYY):______________________________
If not exact, provide explanation:

 Exact  Explanation

B. How was investigation resolved? (select appropriate item):
 Closed Without Further Action  Closed - Regulatory Action Initiated  Other:_______________________
6. Comment (Optional). You may use this space to provide a brief summary of the circumstances leading to the
investigation, as well as the current status or final disposition and/or finding(s).

17

CIVIL JUDICIAL ACTION DISCLOSURE
This Disclosure Form is an  INITIAL or  AMENDED response to report details for affirmative response(s) to
Question(s) 6H on Form MA-I;
Check the question(s) you are responding to, regardless of whether you are answering the question(s) “yes” or
amending the answer(s) to “no”:
 6H(1)(a)
 6H(1)(b)
 6H(1)(c)
 6H(2)
One event may result in more than one affirmative answer to the above items. Use only one Disclosure Form to
report details related to the same event. Unrelated civil judicial actions must be reported on separate Disclosure
Forms.
If the applicant is also registered through the IARD system or CRD system, registered with the SEC as a municipal
advisor on Form MA, or previously registered with the SEC on Form MA-T, or is an associated person of a
municipal advisor that is registered with the SEC on Form MA or that previously registered with the SEC on Form
MA-T, has the applicant or municipal advisor with which it is associated previously submitted a DRP (with Form
ADV, BD, or U4) to the IARD or CRD, or submitted to the SEC disclosure on Form MA-T or a DRP with a Form
MA, for the event that contains the information required by this DRP?  Yes
 No
If the answer is “Yes,” no other information on this DRP must be provided.
NOTE: The completion of this form does not relieve the applicant or any municipal advisor with which it is
associated of its obligation to update its Form MA or its IARD or CRD records.
1. Court Action initiated by:
A. (Select appropriate item):
 SEC
 Other Federal Agency
 Jurisdiction
 Foreign Financial Regulatory Authority
 Municipal Advisory Firm
 Private Plaintiff
B. Name of party initiating the proceeding:___________________________________________
2. Relief Sought: (select all that apply):
 Cease and Desist  Injunction
 Restraining Order  Civil and Administrative Penalty(ies)/Fine(s)
 Monetary Penalty other than Fines  Other:______________________
 Disgorgement
 Restitution
3. A. Filing Date of Court Action (MM/DD/YYYY):_________________  Exact  Explanation
If not exact, provide explanation:
B. Date notice/process was served (MM/DD/YYYY):_________________  Exact  Explanation
If not exact, provide explanation:

18

CIVIL JUDICIAL ACTION DISCLOSURE (CONT.)
4. Product Type(s): (select all that apply)

-Charitable

-DPP & LP
Interest

-Fixed
-Variable
ther than CD)

Preferred Stock)
-OTC
-Financial

-Asset Backed
-Corporate
-Government
-Municipal

ment Trust

5. Formal Action was brought in:
 Federal Court
 State Court
 Foreign Court
 Military Court
 Other:_____________________________
A. Name of Court:____________________________________________________________________
B. Location of Court (City or County and State or Country):_____________________________________________
C. Docket/Case#:______________
6. Employing Municipal Advisory Firm when activity occurred which led to the civil judicial
action:_____________________________
7. Describe the allegations related to this civil action. (Your information must fit within the space provided.):

8. Current Status?
 Pending
 On Appeal
 Final
9. If pending and any limitations or restrictions are currently in effect, provide details:

10. If on appeal:
A. Action appealed to (provide name of court):_______________________________________________________
B. Location of Court (City or County and State or Country):_____________________________________________
C. Docket/Case#:______________
D. Date appeal filed (MM/DD/YYYY):_________________  Exact  Explanation
If not exact, provide explanation:

E. Appeal details (including status):

F. If on appeal and any limitations or restrictions are currently in effect, provide details:
19

CIVIL JUDICIAL ACTION DISCLOSURE (CONT.)
If Final or On Appeal, complete all items below. For Pending Actions, complete Item 13 only.
11. Resolution Detail:
A. How was matter resolved? (Select appropriate item)
 Consent
 Judgment Rendered
 Settled
 Vacated
 Vacated Nunc Pro Tunc / ab initio
 Dismissed
 Withdrawn
 Other: _________________
B. Resolution Date (MM/DD/YYYY):_________________
If not exact, provide explanation:

 Exact  Explanation

12. Sanction Detail:
A.Were any of the following Sanctions Ordered or Relief Granted? (Select all that apply)
Penalty(ies)/Fine(s)

B. Other Sanctions: ___________________________________________________
C. If enjoined, provide:
Injunction Details
Registration Capacities Affected (e.g., General Securities Principal, Financial Operations Principal, All Capacities,
etc.):
Duration (length of time):_________________
If not exact, provide explanation:

 Exact  Explanation

Start Date (MM/DD/YYYY):_________________
If not exact, provide explanation:

 Exact  Explanation

End Date (MM/DD/YYYY):_________________
If not exact, provide explanation:

 Exact  Explanation

Injunction Details
Registration Capacities Affected (e.g., General Securities Principal, Financial Operations Principal, All Capacities,
etc.):
Duration (length of time):_________________
If not exact, provide explanation:

 Exact  Explanation

Start Date (MM/DD/YYYY):_________________
If not exact, provide explanation:

 Exact  Explanation

End Date (MM/DD/YYYY):_________________
If not exact, provide explanation:

 Exact  Explanation

20

CIVIL JUDICIAL ACTION DISCLOSURE (CONT.)
Injunction Details
Registration Capacities Affected (e.g., General Securities Principal, Financial Operations Principal, All Capacities,
etc.):
Duration (length of time):_________________
If not exact, provide explanation:

 Exact  Explanation

Start Date (MM/DD/YYYY):_________________
If not exact, provide explanation:

 Exact  Explanation

End Date (MM/DD/YYYY):_________________
If not exact, provide explanation:

 Exact  Explanation

D. If disposition resulted in a fine, penalty, restitution, disgorgement or monetary compensation, provide:
Monetary Related Sanction Details
Monetary Related Sanction Type:
 Monetary Fine
 Disgorgement
 Restitution
 Other (requires explanation)
Explanation:

Total Amount: $_________________
Portion levied against you: $_________________
Date Paid by You (MM/DD/YYYY):_________________
If not exact, provide explanation:

 Exact  Explanation

Was any portion of penalty waived?
 Yes  No
If yes, amount: $_________________
Monetary Related Sanction Details
Monetary Related Sanction Type:
 Monetary Fine
 Disgorgement
 Restitution
 Other (requires explanation)
Explanation:

Total Amount: $_________________
Portion levied against you: $_________________
Date Paid by You (MM/DD/YYYY):_________________
If not exact, provide explanation:
Was any portion of penalty waived?
 Yes  No
If yes, amount: $_________________

21

 Exact  Explanation

CIVIL JUDICIAL ACTION DISCLOSURE (CONT.)
Monetary Related Sanction Details
Monetary Related Sanction Type:
 Monetary Fine
 Disgorgement
 Restitution
 Other (requires explanation)
Explanation:

Total Amount: $_________________
Portion levied against you: $_________________
Date Paid by You (MM/DD/YYYY):_________________
If not exact, provide explanation:

 Exact  Explanation

Was any portion of penalty waived?
 Yes  No
If yes, amount: $_________________
13. Comment (Optional). You may use this space to provide a brief summary of the circumstances leading to the
action, as well as the current status or disposition and/or finding(s).

22

CUSTOMER COMPLAINT / ARBITRATION / CIVIL LITIGATION DISCLOSURE
This Disclosure Form is an  INITIAL or  AMENDED response to report details for affirmative response(s) to
Question(s) 6I on Form MA-I;
Check the question(s) you are responding to, regardless of whether you are answering the question(s) “yes” or
amending the answer(s) to “no”:
 6I(1)(a)
 6I(2)(a)
 6I(2)(c)
 6I(1)(b)
 6I(2)(b)
One matter may result in more than one affirmative answer to the above items. Use a single Disclosure Form to
report details relating to a particular matter (i.e., a customer complaint/arbitration/CFTC reparation/civil litigation).
Use a separate Disclosure Form for each matter.
If the applicant is also registered through the IARD system or CRD system, registered with the SEC as a municipal
advisor on Form MA, or previously registered with the SEC on Form MA-T, or is an associated person of a
municipal advisor that is registered with the SEC on Form MA or that previously registered with the SEC on Form
MA-T, has the applicant or municipal advisor with which it is associated previously submitted a DRP (with Form
ADV, BD, or U4) to the IARD or CRD, or submitted to the SEC disclosure on Form MA-T or a DRP with a Form
MA, for the event that contains the information required by this DRP?  Yes
 No
If the answer is “Yes,” no other information on this DRP must be provided.
NOTE: The completion of this form does not relieve the applicant or any municipal advisor with which it is
associated of its obligation to update its Form MA or its IARD or CRD records.
Disclosure Instructions:
• Complete items 1-6 for all matters (i.e., customer complaints, arbitrations/CFTC reparations and civil litigation
in which you are not named as a party, as well as arbitrations/CFTC reparations and civil litigation in which you
are named as a party).
• If the matter involves a customer complaint, or an arbitration/CFTC reparation or civil litigation in which you are
not named as a party, complete items 7-11 as appropriate.
• If a customer complaint has evolved into an arbitration/CFTC reparation or civil litigation, amend the existing
Disclosure Form by completing items 9 and 10.
• If the matter involves an arbitration/CFTC reparation in which you are a named party, complete items 12-16, as
appropriate. If the matter involves a civil litigation in which you are a named party, complete items 17-23.
• Item 24 is an optional space and applies to all event types (i.e., customer complaint, arbitration/CFTC reparation,
civil litigation).
Complete items 1-6 for all matters (i.e., customer complaints, arbitrations/CFTC reparations, civil litigation).
1. Customer Name(s):___________________________________________________________________________
2. A. Customer(s) State of Residence (select “not on list” when the customer’s residence is a foreign
address):___________________
B. Other state(s) of residence/detail:
3. Employing Municipal Advisory Firm when activities occurred which led to the customer complaint, arbitration,
CFTC reparation or civil litigation:

4. Allegation(s) and a brief summary of events related to the allegation(s) including dates when activities leading to
the allegation(s) occurred:

23

CUSTOMER COMPLAINT / ARBITRATION / CIVIL LITIGATION DISCLOSURE (CONT.)
5. Product Type(s): (select all that apply)
-Charitable

-DPP & LP
Interest

-Fixed
-Variable
ther than CD)

Preferred Stock)
-OTC
-Financial

-Asset Backed
-Corporate
-Government
-Municipal

ment Trust

6. Alleged Compensatory Damage Amount: $___________________________________________________
 Exact
 Explanation:

If the matter involves a customer complaint, arbitration/CFTC reparation or civil litigation in which you are
not named as a party, complete items 7-11 as appropriate. [Note: Report in Items 12-16, or 17-23, as
appropriate, only arbitrations/CFTC reparations or civil litigation in which you are named as a party.]
7. A. Is this an oral complaint?  Yes  No
B. Is this a written complaint?  Yes  No
C. Is this an arbitration/CFTC reparation or civil litigation?
 Yes  No
If yes, provide:
i. Arbitration/reparation forum or court name and location:______________________________________________
ii. Docket/Case#:______________________________
iii. Filing date of arbitration/CFTC reparation or civil litigation (MM/DD/YYYY):_______________
D. Date received by/served on firm (MM/DD/YYYY):_______________
If not exact, provide explanation:

 Exact  Explanation

8. Is the complaint, arbitration/CFTC reparation or civil litigation pending?  Yes  No
If “No,” complete item 9.
9. If the complaint, arbitration/CFTC reparation or civil litigation is not pending, provide status:
 Closed/No Action
 Withdrawn
 Denied
 Settled
 Arbitration Award/Monetary Judgment (for claimants/plaintiffs)
 Arbitration Award/Monetary Judgment (for respondents/defendants)
 Evolved into Arbitration/CFTC reparation (you are a named party)
 Evolved into Civil litigation (you are a named party)
If status is arbitration/CFTC reparation in which you are not a named party, provide details in item 7C.
If status is arbitration/CFTC reparation in which you are a named party, complete items 12-16.
If status is civil litigation in which you are a named party, complete items 17-23.

24

CUSTOMER COMPLAINT / ARBITRATION / CIVIL LITIGATION DISCLOSURE (CONT.)
10. Status Date (MM/DD/YYYY):_______________
If not exact, provide explanation:

 Exact  Explanation

11. Settlement/Award/Monetary Judgment:
A. Settlement/Award/Monetary Judgment amount: $_________________
B. Your Contribution Amount: $_________________
If the matter involves an arbitration or CFTC reparation in which you are a named respondent, complete
items 12-16, as appropriate.
12. A. Arbitration/CFTC reparation claim filed with (FINRA, AAA, CFTC, etc.):____________________________
B. Docket/Case#:______________________________
C. Date notice/process was served (MM/DD/YYYY):_______________
 Exact  Explanation
If not exact, provide explanation:

13. Is arbitration/ CFTC reparation pending?
If “No,” complete item 14.

 Yes  No

14. If the arbitration/CFTC reparation is not pending, what was the disposition?

(Agent/Representative)
monetary)
_______________________
15. Disposition Date (MM/DD/YYYY):_______________
If not exact, provide explanation:

 Exact  Explanation

16. Monetary Compensation Details (award, settlement, reparation amount):
A. Total Amount: $_________________
B. Your Contribution Amount: $_________________
If the matter involves a civil litigation in which you are a defendant, complete items 17-23.
17. Court in which case was filed:
 Federal Court  State Court

 Foreign Court

 Military Court

 Other: ______________________

A. Name of Court:____________________________________________________________________
B. Location of Court (City or County and State or Country):_____________________________________________
C. Docket/Case#:______________
18. Date received by/served on firm (MM/DD/YYYY):_______________  Exact  Explanation
If not exact, provide explanation:
19. Is the civil litigation pending?  Yes  No
If “No,” complete item 20.
20. If the civil litigation is not pending, what was the disposition?

25

CUSTOMER COMPLAINT / ARBITRATION / CIVIL LITIGATION DISCLOSURE (CONT.)
21. Disposition Date (MM/DD/YYYY):_______________
If not exact, provide explanation:

 Exact  Explanation

22. Monetary Compensation Details (judgment, restitution, settlement amount):
A. Total Amount: $_________________
B. Your Contribution Amount: $_________________
23. If action is currently on appeal:
A. Enter date appeal filed (MM/DD/YYYY):_______________
If not exact, provide explanation:

B. Court appeal filed in:
 Federal Court  State Court

 Foreign Court

 Exact  Explanation

 Military Court

 Other: ______________________

A. Name of Court:____________________________________________________________________
B. Location of Court (City or County and State or Country):____________________________________________
C. Docket/Case#:______________
24. Comment (Optional). You may use this space to provide a brief summary of the circumstances leading to the
customer complaint, arbitration/CFTC reparation and/or civil litigation as well as the current status or final
disposition(s). Your information must fit within the space provided.

26

TERMINATION DISCLOSURE
This Disclosure Form is an  INITIAL or  AMENDED response to report details for affirmative response(s) to
Question(s) 6J on Form MA-I;
Check the question(s) you are responding to, regardless of whether you are answering the question(s) “yes” or
amending the answer(s) to “no”:
 6J(1)
 6J(2)
 6J(3)
One event may result in more than one affirmative answer to the above items. Use only one Disclosure Form to
report details to the same termination. Use a separate Disclosure Form for each termination reported.
If the applicant is also registered through the IARD system or CRD system, registered with the SEC as a municipal
advisor on Form MA, or previously registered with the SEC on Form MA-T, or is an associated person of a
municipal advisor that is registered with the SEC on Form MA or that previously registered with the SEC on Form
MA-T, has the applicant or municipal advisor with which it is associated previously submitted a DRP (with Form
ADV, BD, or U4) to the IARD or CRD, or submitted to the SEC disclosure on Form MA-T or a DRP with a Form
MA, for the event that contains the information required by this DRP?  Yes
 No
If the answer is “Yes,” no other information on this DRP must be provided.
NOTE: The completion of this form does not relieve the applicant or any municipal advisor with which it is
associated of its obligation to update its Form MA or its IARD or CRD records.
1. Municipal Advisory Firm Name:_________________________________________________
2. Termination Type:
 Discharged
 Permitted to Resign
 Voluntary Resignation
3. Termination Date (MM/DD/YYYY):_______________________________  Exact  Explanation
If not exact, provide explanation:

4. Allegation(s):

5. Product Type(s): (select all that apply)

-Charitable

-DPP & LP
Interest

-Fixed
-Variable
ther than CD)

Preferred Stock)
-OTC
-Financial

-Asset Backed
-Corporate
-Government
-Municipal

ment Trust

6. Comment (Optional). You may use this space to provide a brief summary of the circumstances leading to the
termination. Your information must fit within the space provided.

27

JUDGMENT / LIEN DISCLOSURE
This Disclosure Form is an  INITIAL or  AMENDED response to report details for affirmative response(s) to
Question(s) 6M on Form MA-I;
Check the question(s) you are responding to, regardless of whether you are answering the question “yes” or
amending the answer(s) to “no”:
 6M
If multiple, unrelated events result in the same affirmative answer, details must be provided on separate Disclosure
Forms.
If the applicant is also registered through the IARD system or CRD system, registered with the SEC as a municipal
advisor on Form MA, or previously registered with the SEC on Form MA-T, or is an associated person of a
municipal advisor that is registered with the SEC on Form MA or that previously registered with the SEC on Form
MA-T, has the applicant or municipal advisor with which it is associated previously submitted a DRP (with Form
ADV, BD, or U4) to the IARD or CRD, or submitted to the SEC disclosure on Form MA-T or a DRP with a Form
MA, for the event that contains the information required by this DRP?  Yes
 No
If the answer is “Yes,” no other information on this DRP must be provided.
NOTE: The completion of this form does not relieve the applicant or any municipal advisor with which it is
associated of its obligation to update its Form MA or its IARD or CRD records.
1. Judgment/Lien Amount:$_____________________________________
2. Judgment/Lien Holder:_____________________________________
3. Judgment/Lien Type:  Civil  Tax
4. Date Filed (MM/DD/YYYY):_______________________________  Exact  Explanation
If not exact, provide explanation:
5. Court action brought in:
 Federal Court  State Court  Foreign Court  Other:__________________
A. Name of Court:____________________________________________________________________
B. Location of Court (City or County and State or Country):_____________________________________________
C. Docket/Case#:______________
 Check this box if the Docket/Case# is your SSN, a Bank Card number, or a Personal Identification Number.
6. Is Judgment/Lien outstanding?  Yes  No
If “No,” complete item 7. If “Yes,” skip to item 8.
7. If Judgment/Lien is not outstanding, provide:
A. Status Date (MM/DD/YYYY):_______________________________
If not exact, provide explanation:

B. How was matter resolved? (select appropriate item):

 Exact  Explanation

 Discharged  Released  Removed  Satisfied

6. Comment (Optional). You may use this space to provide a brief summary of the circumstances leading to the
action as well as the current status or final disposition. Your information must fit within the space provided.

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