FORM MA-I/A
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
OMB APPROVAL
AMENDMENT TO THE MUNICIPAL ADVISOR’S MOST RECENT FORM MA-I
OMB Number: 3235-0681
Estimated average burden hours per response: 0.5
Form MA-I Applicant's Information
Filer's CIK:
0001620860
Filer's CCC:
Submission Contact Information
Name:
Brian Braham
Phone:
913--748-4736
Email Address:
cbraham@irr.com
Notification Information
Notification will automatically be sent to the Login CIK, Submission Contact, and Primary Issuers. Specify additional addresses below.
Email Address:
jhansen@irr.com
Please read the General Instructions for this form and other forms in the MA series, as well as its subsection, "Specific Instructions for Form MA-I," before completing this form. All italicized terms herein are defined or described in the Glossary of Terms appended to the General Instructions.
PART 1
This form must be completed by
Every municipal advisory firm applying for registration or registered as a municipal advisor on Form MA, to provide information regarding each natural person who is an associated person of the firm and engages in municipal advisory activities on the firm's behalf (for purposes of Form MA-I, the "individual"); and
Every natural person (sole proprietor) applying for registration as a municipal advisor on Form MA, to provide additional personal information.
WARNING
Complete this form truthfully. False statements or omissions may result in denial of a municipal advisor's application, revocation or suspension of such registration, or criminal prosecution. Form MA-I must be amended promptly whenever any information previously provided becomes inaccurate. See General Instruction 9.
Type of Filing:
This is an (check the appropriate box):
Initial Form MA-I Execution Pages: Before submitting this form, you must complete the Execution Page.
Supporting Documentation: If you are required to make reportable disclosures in the Disclosure Reporting Pages, you must attach the supporting documentation.
Non-Resident Individuals: If the individual is a non-resident of the United States, you must attach a completed Form MA-NR signed by the individual to this Form MA-I at the time of initial filing of Form MA-I. See the General Instructions.
Amendment to the most recent Form MA-I 
Amendment to indicate that the individual is no longer an associated person of the municipal advisory firm or no longer engages in municipal advisory activities on its behalf. (If you check this box, complete only Item 1-A and Item 7 below.)Item 1 Identifying Information
A. The Individual
Full Legal Name:
Enter all the letters of each name and not initials or other abbreviations. If no middle name, enter NMN on that line.
Last Name:
Doherty
First Name:
Travis
Middle Name:
William
Suffix:
Individual CRD No.: (if any)
B. Municipal Advisory Firms Where the Individual Is Employed
In providing your responses, please note that the definition of "employee" for purposes of this form includes an independent contractor who engages in municipal advisory activities on behalf of a municipal advisory firm. See Glossary of Terms.
Is the individual employed at more than one municipal advisory firm?
YES 
NO Enter the number of municipal advisory firms the individual is employed with (sole proprietors not employed with any other firm enter 1).
(For individuals who are employed with more than one firm, provide the information required by this Item 1-B for each such firm. For sole proprietors, enter the legal name under which you conduct your municipal advisor-related activities, and skip to Item 1-B.1.)
1
Municipal Advisory Firm's CIK:
Full Legal Name of municipal advisory firm with which the individual is employed:
IRR Corporate & Public Finance, LLC
Name under which municipal advisor-related business is primarily conducted, if different from above:
Date that the individual's most recent employment with this municipal advisory firm commenced (MM/DD/YYYY):
07-05-2018
Does the individual have an independent contractor relationship with the above-named firm?
YES NO (1) Municipal Advisory Firm's Registration Information:
Notification will automatically be sent to the Login CIK, Submission Contact, and Primary Issuers. Specify additional addresses below.
Is the municipal advisory firm currently registered on Form MA as a municipal advisor? (Answer "Yes" if you have already filed Form MA and your application for registration on that form has been approved. Otherwise, answer "No.")
YES NO SEC File No.:
867-01285
(2) Office
Enter the requested information for each office of the municipal advisory firm where the individual is or will be physically located, and each office from which the individual is or will be supervised:
The individual is or will be Located At Supervised From
Located At Supervised From Start Date:
07-05-2018
Street Address 1:
1901 W. 47TH PLACE
Street Address 2:
SUITE 102
City:
WESTWOOD
State/Country:
KS
Postal Code:
66205
Private Residence Check Box: Is the Office of Employment address a private residence?
A private residential address will not be included in publicly available versions of this registration form.
YES NO Item 2 Other Names
Enter the following information for all other names that the individual has used or is using, or by which the individual is known or has been known, other than the individual´s legal name, since the age of 18.
This space should include, for example, nicknames, aliases, and names used before or after marriage.
Item 3 Residential History
Starting with the current address, enter the following information for all the individual´s residential addresses for the past 5 years. Leave no gaps greater than three months between addresses. Report changes in an amendment to this form as they occur in the future. Private residential addresses will not be included in publicly available versions of this form.
Current Address
From:
To:
Street Address 1:
Street Address 2:
City:
State/Country:
Postal Code:
Item 4 Employment History
Provide complete employment history of the individual for the past 10 years. Include the municipal advisory firm(s) entered in Item 1-B. Enter the following information for each employer. Account for all time, leaving no gaps longer than three months. Include 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. Such statuses should be entered in the space provided below for "Name of Municipal Advisory Firm or Company."
Current Employer
From:
07-2018
To: of Municipal Advisory Firm or Company:
Name of Municipal Advisory Firm or Company:
IRR Corporate & Public Finance, LLC
City: of Municipal Advisory Firm or Company:
Westwood
State/Country: of Municipal Advisory Firm or Company:
KS
Postal Code:
66205
Municipal Advisor-Related Business?
YES NO Investment-Related Business?
YES NO Position Held:
Analyst
Prior to the Above
Prior employment history must be entered in reverse chronological order.
Prior Address
From (MM/YYYY):
08-2007
To (MM/YYYY):
07-2018
Name of Municipal Advisory Firm or Company:
Dickinson Financial Corporation
City:
Kansas City
State/Country:
MO
Postal Code:
66105
Municipal Advisor-Related Business?
YES NO Investment-Related Business?
YES NO Position Held:
OREO Officer, VP
Item 5 Other Business
Is the individual currently engaged in any other business either as a proprietor, partner, officer, director, employee, trustee, agent or otherwise?
YES NO Item 6 Disclosure Information
IF THE ANSWER TO ANY OF THE QUESTIONS IN ITEMS 6A – 6J AND 6M IS "YES," PROVIDE DETAILS OF ALL EVENTS OR PROCEEDINGS ON THE APPROPRIATE DISCLOSURE REPORTING PAGES (DRPs).
One event or proceeding may result in the requirement to answer "Yes" to more than one question below.
Refer to the Glossary of Terms for definitions or descriptions of italicized terms.
CRIMINAL ACTION DISCLOSURE
If the answer is "Yes" to any question below in Item 6A or 6B, complete a Criminal Action DRP.
Item 6A.
(1) Has the individual ever:
(a) been convicted of any felony, or pled guilty or nolo contendere ("no contest") to any charge of a felony in a domestic, foreign, or military court?
YES NO (b) been charged with any felony?
YES NO (2) Based upon activities that occurred while the individual exercised control over it, has an organization ever:
(a) been convicted of any felony or pled guilty or nolo contendere ("no contest") in a domestic or foreign court to any charge of a felony?
YES NO (b) been charged with any felony?
YES NO Item 6B.
(1) Has the individual ever:
(a) been convicted of any misdemeanor or pled guilty or nolo contendere ("no contest") in a domestic, foreign or military court to any charge of 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?
YES NO (b) been charged with any misdemeanor of the kind described in 6B(1)(a)?
YES NO (a) been convicted of any misdemeanor or pled guilty or nolo contendere ("no contest") in a domestic or foreign court to any charge of a misdemeanor of the kind specified in 6B(1)(a)?
YES NO (b) been charged with any misdemeanor of the kind specified in 6B(1)(a)?
YES NO REGULATORY ACTION DISCLOSURE
If the answer is "Yes" to any question below in Items 6C-6G(1), complete a Regulatory Action DRP.
Item 6C.
Has the SEC or the CFTC ever:
(1) found the individual to have made a false statement or omission?
YES NO (2) found the individual to have been involved in a violation of any SEC or CFTC regulation or statute?
YES NO (3) found the individual to have been a cause of a denial, suspension, revocation, or restriction of the authorization of a municipal advisor-related business or investment-related business to operate?
YES NO (4) entered an order against the individual in connection with municipal advisor-related or investment-related activity?
YES NO (5) imposed a civil money penalty on the individual, or ordered the individual to cease and desist from any activity?
YES NO (6) found the individual 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 MSRB, or found the individal to have been unable to comply with any provision of such Acts, rules or regulations?
YES NO (7) found the individual 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 MSRB?
YES NO (8) found the individual to have failed reasonably to supervise another person subject to his or her 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 MSRB?
YES NO Item 6D.
(1) Has any other federal regulatory agency or any state regulatory agency or foreign financial regulatory authority ever:
(a) found the individual to have made a false statement or omission or to have been dishonest, unfair or unethical?
YES NO (b) found the individual to have been involved in a violation of municipal advisor-related or investment-related regulation(s) or statute(s)?
YES NO (c) found the individual to have been a cause of a denial, suspension, revocation, or restriction of the authorization of a municipal advisor-related or investment-related business to operate?
YES NO (d) entered an order against the individual in connection with a municipal advisor-related or investment-related activity?
YES NO (e) denied, suspended, or revoked the individual's registration or license or otherwise, by order, prevented the individual from associating with a municipal advisor-related or investment-related business or restricted his or her activities?
YES NO (2) Has the individual ever been subject to any final order of a state securities commission (or any agency or office performing like functions), a state authority that supervises or examines banks, savings associations, or credit unions, a state insurance commission (or any agency or office performing like functions), a federal banking agency, or the National Credit Union Administration, that:
(a) bars the individual from association with an entity regulated by such commission, authority, agency, or office, or from engaging in the business of securities, insurance, banking, savings association activities, or credit union activities; or
YES NO (b) is based on violations of any laws or regulations that prohibit fraudulent, manipulative, or deceptive conduct?
YES NO Item 6E.
Has any self-regulatory organization or commodities exchange ever:
(1) found the individual to have made a false statement or omission?
YES NO (2) found the individual 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) found the individual to have been a cause of a denial, suspension, revocation, or restriction of the authorization of a municipal advisor-related or investment-related business to operate?
YES NO (4) disciplined the individual by expelling or suspending him or her from membership, barring or suspending the individual's association with its members, or restricting the individual's activities?
YES NO (5) found the individual 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 MSRB, or found the individual to have been unable to comply with any provision of such Acts, rules or regulations?
YES NO (6) found the individual 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 MSRB?
YES NO (7) found the individual 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 MSRB?
YES NO Item 6F.
Has the individual ever had an authorization to act as an attorney, accountant or federal contractor that was revoked or suspended?
YES NO Item 6G.
Has the individual been notified, in writing, that he or she is currently the subject of any:
(1) regulatory complaint or proceeding that could result in a "Yes" answer to any part of 6C, D or E?
YES NO INVESTIGATION DISCLOSURE
If the answer is "Yes" to Item 6G(2) below, complete an Investigation DRP.
(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 CIVIL JUDICIAL ACTION DISCLOSURE
If the answer is "Yes" to any question below in Item 6H, complete a Civil Judicial Action DRP.
Item 6H.
(1) Has any domestic or foreign court ever:
(a) enjoined the individual in connection with any municipal advisor-related or investment-related activity?
YES NO (b) found that the individual was involved in a violation of any municipal advisor-related or investment-related statute(s) or regulation(s)?
YES NO (c) dismissed, pursuant to a settlement agreement, a municipal advisor-related or investment-related civil action brought against the individual by a domestic jurisdiction or foreign financial regulatory authority?
YES NO (2) Is the individual named in any currently pending civil proceeding that could result in a "Yes" answer to any part of 6H(1)?
YES NO CUSTOMER COMPLAINT/ARBITRATION/CIVIL LITIGATION DISCLOSURE
If the answer is "Yes" to any question below in Item 6I, complete a Customer Complaint/Arbitration/Civil Litigation DRP.
Item 6I.
(1) Has the individual ever been the subject of a municipal advisor-related or investment-related, customer-initiated (written or oral) complaint that alleged that he or she was involved in fraud, false statements, omissions, theft, embezzlement, wrongful taking of property, bribery, forgery, counterfeiting, extortion, or dishonest, unfair or unethical practices, which:(a) is still pending, or;
YES NO (b) was settled?
YES NO (a) is still pending, or;
YES NO (b) resulted in an arbitration award or civil judgment against the individual, regardless of amount, or;
YES NO (c) was settled?
YES NO TERMINATION DISCLOSURE
If the answer is "Yes" to any question below in Item 6J, complete a Termination DRP.
Item 6J.
Has the individual ever voluntarily resigned, been discharged or permitted to resign after allegations were made that accused him or her of:
(1) violating municipal advisor-related or investment-related statutes, regulations, rules, or industry standards of conduct?
YES NO (2) fraud or the wrongful taking of property?
YES NO (3) failure to supervise in connection with municipal advisor-related or investment-related statutes, regulations, rules or industry standards of conduct?
YES NO FINANCIAL DISCLOSURE
Item 6K.
Within the past 10 years:
(1) has the individual made a compromise with creditors, filed a bankruptcy petition or been the subject of an involuntary bankruptcy petition?
YES NO (2) based upon events that occurred while the individual 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?
YES NO (3) based upon events that occurred while the individual exercised control over it, has a broker or dealer been the subject of an involuntary bankruptcy petition, had a trustee appointed, or had a direct payment procedure initiated under the Securities Investor Protection Act?
YES NO Item 6L.
Has a bonding company ever denied, paid out on, or revoked a bond for the individual?
YES NO JUDGMENT/LIEN DISCLOSURE
If the answer is "Yes" to any question below in Item 6M, complete a Judgment/Lien DRP.
Item 6M.
Are there currently any unsatisfied judgments or liens against the individual?
YES NO Item 7 Signature and Self-Certification
NOTE: In addition to completing Item 7, to the extent that the individual is a non-resident, a Form MA-NR completed and signed by the individual must be attached as an exhibit to this Form MA-I.
Complete Either Subpart A or Subpart B:
By typing a name in the signature field, the signatory acknowledges and represents that the entry constitutes in every way, use, or aspect, his or her legally binding signature.
A. For Municipal Advisory Firms filing this form:
The municipal advisory firm has obtained and retained written consent from the individual that service of any civil action brought by, or notice of any proceeding before, the SEC or any self-regulatory organization in connection with the individual's municipal advisory activities may be given by registered or certified mail to the individual's address given in Item 1.
I, the undersigned, sign this Form MA-I on behalf of, and with the authority of, the municipal advisory firm that is filing this form. The municipal advisory firm and I both 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 as a free and voluntary act.
Date:
03-10-2020
By (signature):
John K. Hansen
Title:
Managing Director / CCO
B. For Natural Person Municipal Advisors (Sole Proprietors) filing this form:
The individual named below consents that service of any civil action brought by, or notice of any proceeding before, the SEC or any self-regulatory organization in connection with the individual's municipal advisory activities may be given by registered or certified mail to the individual's address given in Item 1.
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:
Enter all the letters of each name and not initials or other abbreviations. If no middle name, enter NMN on that line.
Last Name:
First Name:
Middle Name:
Suffix:
Individual CRD No. (if any):
By (signature):
Warning: Intentional misstatements or omissions of fact constitute Federal criminal violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).12.
CRIMINAL ACTION DISCLOSURE REPORTING PAGE (MA-I)
CRIMINAL ACTION DRP – PART 1
This Disclosure Reporting Page (DRP MA-I) 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) to which this DRP pertains:
6A(1)(a)6A(1)(b)6A(2)(a)6A(2)(b)6B(1)(a)6B(1)(b)6B(2)(a)6B(2)(b)Is this DRP an amendment that seeks to remove a previously filed DRP concerning the individual from the record?
YES NOIf "Yes," the reason the DRP should be removed is:
The event or proceeding was resolved in the individual's favor
The DRP was filed in error.
Explain the circumstances:
How to Report an Event or Proceeding on a Criminal Action DRP: Use a separate DRP for each event or proceeding. One event may result in more than one affirmative answer to Items 6A(1)(a), 6A(1)(b), 6A(2)(a), 6A(2)(b), 6B(1)(a), 6B(1)(b), 6B(2)(a), and/or 6B(2)(b). Use this DRP to report all charges, including multiple counts of the same charge, arising out of the same event and filed in one criminal action. Separate cases arising out of the same event, and unrelated criminal actions, must be reported on separate DRPs.
How to Provide Court Documents: Applicable court documents (i.e., criminal complaint, information or indictment, as well as judgment of conviction or sentencing documents) must be attached as an exhibit if not previously submitted.
DRP On File for This Event:Is an accurate and up-to-date DRP containing the information regarding the individual required by this DRP already on file (a) in the IARD or CRD system (with a Form ADV, BD, or U4), or (b) in the SEC's EDGAR system (with a Form MA or Form MA-I)?
Note: The filer may identify a DRP filed by the individual directly, or filed by another SEC-registrant about the individual as an associated person.
NOTE: The completion of all or any part of this form does not relieve the individual or any municipal advisor with which the individual is associated of the obligation to update any relevant Form MA or IARD or CRD records.
CRIMINAL ACTION DRP – PART 2
1. Firm or Organization
A. Were charge(s) brought against a firm or organization over which the individual exercise(d) control?
YES NO B. If "Yes," Provide the following information:
(1) Enter the firm or organization name:
(2) Was the firm or organization engaged in a municipal advisor-related or investment-related business?
YES NO (3) What was the individual's position, title or relationship with the firm or organization?
2. Court Where Formal Charge(s) Were Brought: (File a separate Criminal Action DRP for charges brought in separate courts and / or separate cases in the same court. If brought in a foreign jurisdiction, provide all the information below in English.):
Federal Court Military Court State Court Foreign Country Court International Court Other: Municipal
A. Name of the Court:
Flagstaff Municipal Court
B. Location of the Court:
Street Address:
15 North Beaver St.
City or County:
Flagstaff
State / Country:
AZ
Postal Code:
86001
C. Docket / Case Name:
State of AZ vs. Doherty
D. Docket / Case Number:
M-0341-CR-2002000281
3. Event Disclosure Detail (Use this for both organizational and individual charges.)
A. Date First Charged (MM/DD/YYYY):
01-28-2002
If not exact, provide explanation:
B. Details of Event: Report all charges separately.
For each charge, provide the following information.
(1) First Charge
(a) List the charge / charge description:
Shoplifting
(b) Number of counts:
1
(c) Check the appropriate box:
FelonyMisdemeanor(d) Plea for this charge:
Guilty
(e) (i) Is the charge municipal advisor-related?
Yes No(ii) If "Yes," what is the product type?
(f) (i) Is the charge investment-related?
Yes No(ii) If "Yes," what is the product type?
(g) (i) Amended Charge: Indicate if the original charge was amended or reduced:
Yes No(ii) If "Yes," provide the date the charge was amended or reduced:
C. FelonyCharge(s): Did any of the charge(s) within the event involve a felony?
Yes No 4. Current Status of the Event:
5. Event Status Date (Complete unless status is pending) (MM/DD/YYYY):
If not exact, provide explanation:
6. On Appeal – Judicial Review: If you checked "On Appeal" in Item 4, to whom was the criminal action appealed? (If brought in a foreign jurisdiction, provide all the information below in English):
Federal Court Military Court State Court Foreign Country Court International Court Other: (specify) A. Name of the Court:
B. Location of the Court:
Street Address:
City or County:
State / Country:
Postal Code:
C. Docket / Case Name:
D. Docket / Case Number:
E. Date Appeal filed (MM/DD/YYYY):
For Item 7: If you checked "Final" or "On Appeal" in Item 4, complete Item 7. For actions that are "Pending," skip to Item 8.
7. Disposition Disclosure Detail (For each charge, provide the following information):
(a) First Charge
(1) Disposition of the Charge:
Check all that apply.
AcquittedFound not guilty Pre-trial diversion/interventionAmended Pled guiltyReducedConvictedPled nolo contendere Other (requires explanation) Deferred Adjudication Pled not guilty Dismissed Appealed Affirmed Vacated & Returned For Further Action Vacated/Final Other (requires explanation) Explanation:
If more than one disposition is checked, and/or "Other" is checked, or the above otherwise does not adequately summarize the disposition of the charge, provide an explanation.
(2) Date (MM/DD/YYYY):
(3) Sentence / Penalty: Is a sentence or other penalty ordered?
Yes No If "Yes," list each type (e.g. prison, jail, probation, community service, counseling, education, other - specify):
Fine
(4) Was or is the individual incarcerated in connection with this sentence?
Yes No If "Yes," provide the following details:
(i) Duration (length of the sentence):
Days
Months
Years
(ii) Start Date of Penalty (MM/DD/YYYY):
Not determined. (iii) End Date of Penalty (MM/DD/YYYY):
Not determined.(iv) Is the sentence to be served concurrently with any other sentence?
Yes NoIf "Yes," indicate the end date of the concurrent sentence (MM/DD/YYYY):
(v) Explanation (Optional):
(5) Monetary Penalty / Fine:
(i) Was a monetary penalty/fine imposed?
Yes NoIf "Yes," provide the following details in (ii) and (iii) below:
(ii) Total Penalty/Fine Amount:$
$
(iii) Was any portion suspended/reduced?
Yes NoIf "Yes," how much? $
$
(iv) Final Amount:
$
(v) Was the final amount paid in full?
Yes NoIf "Yes," date paid in full (MM/DD/YYYY):
If "No," indicate the amount unpaid:
$
And explain the circumstances:
8. Summary of Circumstances (Optional): You may use this space to provide a brief summary of circumstances leading to the charge(s), as well as the current status or final disposition, if any. Include the relevant dates when the conduct which was the subject of the charge(s) occurred, and any other relevant information. The information must fit within the space provided.
Judgement Set Aside 11/20/2014
CRIMINAL ACTION DISCLOSURE REPORTING PAGE (MA-I)
CRIMINAL ACTION DRP – PART 1
This Disclosure Reporting Page (DRP MA-I) 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) to which this DRP pertains:
6A(1)(a)6A(1)(b)6A(2)(a)6A(2)(b)6B(1)(a)6B(1)(b)6B(2)(a)6B(2)(b)Is this DRP an amendment that seeks to remove a previously filed DRP concerning the individual from the record?
YES NOIf "Yes," the reason the DRP should be removed is:
The event or proceeding was resolved in the individual's favor
The DRP was filed in error.
Explain the circumstances:
How to Report an Event or Proceeding on a Criminal Action DRP: Use a separate DRP for each event or proceeding. One event may result in more than one affirmative answer to Items 6A(1)(a), 6A(1)(b), 6A(2)(a), 6A(2)(b), 6B(1)(a), 6B(1)(b), 6B(2)(a), and/or 6B(2)(b). Use this DRP to report all charges, including multiple counts of the same charge, arising out of the same event and filed in one criminal action. Separate cases arising out of the same event, and unrelated criminal actions, must be reported on separate DRPs.
How to Provide Court Documents: Applicable court documents (i.e., criminal complaint, information or indictment, as well as judgment of conviction or sentencing documents) must be attached as an exhibit if not previously submitted.
DRP On File for This Event:Is an accurate and up-to-date DRP containing the information regarding the individual required by this DRP already on file (a) in the IARD or CRD system (with a Form ADV, BD, or U4), or (b) in the SEC's EDGAR system (with a Form MA or Form MA-I)?
Note: The filer may identify a DRP filed by the individual directly, or filed by another SEC-registrant about the individual as an associated person.
NOTE: The completion of all or any part of this form does not relieve the individual or any municipal advisor with which the individual is associated of the obligation to update any relevant Form MA or IARD or CRD records.
CRIMINAL ACTION DRP – PART 2
1. Firm or Organization
A. Were charge(s) brought against a firm or organization over which the individual exercise(d) control?
YES NO B. If "Yes," Provide the following information:
(1) Enter the firm or organization name:
(2) Was the firm or organization engaged in a municipal advisor-related or investment-related business?
YES NO (3) What was the individual's position, title or relationship with the firm or organization?
2. Court Where Formal Charge(s) Were Brought: (File a separate Criminal Action DRP for charges brought in separate courts and / or separate cases in the same court. If brought in a foreign jurisdiction, provide all the information below in English.):
Federal Court Military Court State Court Foreign Country Court International Court Other: Municipal
A. Name of the Court:
Flagstaff Municipal Court
B. Location of the Court:
Street Address:
15 North Beaver St.
City or County:
Flagstaff
State / Country:
AZ
Postal Code:
86001
C. Docket / Case Name:
State of AZ vs. Doherty Travis
D. Docket / Case Number:
M-0341-CR-2003001484
3. Event Disclosure Detail (Use this for both organizational and individual charges.)
A. Date First Charged (MM/DD/YYYY):
05-19-2003
If not exact, provide explanation:
B. Details of Event: Report all charges separately.
For each charge, provide the following information.
(1) First Charge
(a) List the charge / charge description:
Theft
(b) Number of counts:
1
(c) Check the appropriate box:
FelonyMisdemeanor(d) Plea for this charge:
Guilty/No Contest
(e) (i) Is the charge municipal advisor-related?
Yes No(ii) If "Yes," what is the product type?
(f) (i) Is the charge investment-related?
Yes No(ii) If "Yes," what is the product type?
(g) (i) Amended Charge: Indicate if the original charge was amended or reduced:
Yes No(ii) If "Yes," provide the date the charge was amended or reduced:
C. FelonyCharge(s): Did any of the charge(s) within the event involve a felony?
Yes No 4. Current Status of the Event:
5. Event Status Date (Complete unless status is pending) (MM/DD/YYYY):
If not exact, provide explanation:
6. On Appeal – Judicial Review: If you checked "On Appeal" in Item 4, to whom was the criminal action appealed? (If brought in a foreign jurisdiction, provide all the information below in English):
Federal Court Military Court State Court Foreign Country Court International Court Other: (specify) A. Name of the Court:
B. Location of the Court:
Street Address:
City or County:
State / Country:
Postal Code:
C. Docket / Case Name:
D. Docket / Case Number:
E. Date Appeal filed (MM/DD/YYYY):
For Item 7: If you checked "Final" or "On Appeal" in Item 4, complete Item 7. For actions that are "Pending," skip to Item 8.
7. Disposition Disclosure Detail (For each charge, provide the following information):
(a) First Charge
(1) Disposition of the Charge:
Check all that apply.
AcquittedFound not guilty Pre-trial diversion/interventionAmended Pled guiltyReducedConvictedPled nolo contendere Other (requires explanation) Deferred Adjudication Pled not guilty Dismissed Appealed Affirmed Vacated & Returned For Further Action Vacated/Final Other (requires explanation) Explanation:
If more than one disposition is checked, and/or "Other" is checked, or the above otherwise does not adequately summarize the disposition of the charge, provide an explanation.
(2) Date (MM/DD/YYYY):
(3) Sentence / Penalty: Is a sentence or other penalty ordered?
Yes No If "Yes," list each type (e.g. prison, jail, probation, community service, counseling, education, other - specify):
Fine
(4) Was or is the individual incarcerated in connection with this sentence?
Yes No If "Yes," provide the following details:
(i) Duration (length of the sentence):
Days
Months
Years
(ii) Start Date of Penalty (MM/DD/YYYY):
Not determined. (iii) End Date of Penalty (MM/DD/YYYY):
Not determined.(iv) Is the sentence to be served concurrently with any other sentence?
Yes NoIf "Yes," indicate the end date of the concurrent sentence (MM/DD/YYYY):
(v) Explanation (Optional):
(5) Monetary Penalty / Fine:
(i) Was a monetary penalty/fine imposed?
Yes NoIf "Yes," provide the following details in (ii) and (iii) below:
(ii) Total Penalty/Fine Amount:$
$
(iii) Was any portion suspended/reduced?
Yes NoIf "Yes," how much? $
$
(iv) Final Amount:
$
(v) Was the final amount paid in full?
Yes NoIf "Yes," date paid in full (MM/DD/YYYY):
If "No," indicate the amount unpaid:
$
And explain the circumstances:
8. Summary of Circumstances (Optional): You may use this space to provide a brief summary of circumstances leading to the charge(s), as well as the current status or final disposition, if any. Include the relevant dates when the conduct which was the subject of the charge(s) occurred, and any other relevant information. The information must fit within the space provided.
Judgement Set Aside 11/20/2014