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

Rule 15Ba2-6T and Form MA-T-Temporary Registration of Municipal Advisors

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Form MA-T

OMB: 3235-0659

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OMB Number: 3235-0659
Expires: March 31, 2011
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Per amendment: 0.5

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): ____________________________

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H. Municipal advisor’s principal office and place of business:
(1)

Address
	
(do not use a P.O. Box):
__________________________________________________________________
(number and street)

__________________________________________________________________
(city)

(2) 	

	

(state/country)

(zip+4/postal code)

Telephone number at this location: _____________________________________
(area code)

(3) 	

(telephone number)

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. C
	 ontact 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)

_____________________@____________________________ 

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


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(zip+4/postal code)

ITEM 2 - MUNICIPAL ADVISORY ACTIVITIES
What type(s) of municipal advisory services does the municipal advisor provide? Check all
that apply.







(1)
(2)
(3)
(4)
(5)
(6)



(7) 	



(8)

Advice concerning the issuance of municipal securities
Advice concerning the investment of the proceeds of municipal securities
Advice concerning guaranteed investment contracts
Recommendation and/or brokerage of municipal escrow investments
Advice concerning the use of municipal derivatives (e.g., swaps)
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)
Preparation of feasibility studies, tax or revenue projections, or similar
products in connection with offerings or potential offerings of municipal
securities
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.

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B. In the past ten years, has the municipal advisor or any associated municipal advisor
professional:
(1) 	

(2) 	

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
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

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(4) 	

in the past ten years, entered an order against the municipal advisor or any
associated municipal advisor professional in connection with an investmentrelated 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)

e	 ver 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

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(2) 	

(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

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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File Typeapplication/pdf
File TitleForm MA-T Printable Version
Subjectdate: 2010-09-01
AuthorUS Securities and Exchange Commission
File Modified2010-09-02
File Created2010-09-02

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