Form SEC-2205 Form N-17f-1

UNITED STATES
ECURITIES AND EXCHANGE COMMISSION
S

Washington, D.C. 20549

FORM N-17f-1

OMB APPROVAL
OMB Number:
3235-0359
Expires: December 31, 2014
Estimated average burden
hours per response. . . . . .1.5

ertificate of Accounting of Securities and Similar
C
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):

INSTRUCTIONS
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.

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