FORM MA-W
Notice of Withdrawal from Registration as a Municipal Advisor
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
OMB Number: 3235-0681
Estimated average burden hours per response: 0.5
Filer Information
Filer CIK:
Filer CCC:
File Number:
Contact Information
Benjamin Allen
Name:
614-423-8155
Phone:
ballen@disclosureadvisors.com
Email Address:
Notification Information
Notification will automatically be sent to the Login CIK, Submission Contact, and Primary Issuers. Specify additional addresses below.
Notification Email Address:
Item 1 Identifying Information
Item 2 Contact Person (for Municipal Advisory Firms)
- The registrant's contact person must be a principal or employee (not outside counsel) of the municipal advisor authorized to receive information and respond to questions about this Form MA-W.
- Name, title, and contact information:
City:
State/Country:
Postal Code:
Telephone Number:
Email Address:
Item 3 Money Owed to Clients
Has the registrant:
Yes 
No Yes No Item 4 Advisory Contract Assignments
Yes No Item 5 Judgments and Liens
Yes No Item 6 Books and Records
NOTE: Rule 15Ba1-8 under the Exchange Act requires a municipal advisor to preserve its books and records after the municipal advisor ceases to conduct or discontinues business as a municipal advisor.
Provide in Schedule W1 the name and address of each person who has or will have custody or possession of the municipal advisor's books and records and each location at which any of such books and records are or will be kept.
Item 7 Statement of Financial Condition
If registrant answered "Yes" to Item 3A, Item 3B, or Item 5, complete Schedule W2, disclosing the nature and amount of the registrant's assets and liabilities and net worth as of the last day of the month prior to the filing of this Form MA-W.
Execution
For a Sole Proprietor:
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-W, including exhibits and any other information submitted, are true. I further certify that the books and records of my municipal advisor-related business will be preserved and available for inspection as required by law, and that all information submitted on my most recent Form MA and Form MA-I is accurate and complete as of this date. I understand that if any information contained in this Form MA-W is different from the information contained on my Form MA and Form MA-I, the information on this Form MA-W will replace the corresponding entry on my Form MA and Form MA-I. Finally, I authorize any person having custody or possession of these books and records to make them available to authorized regulatory representatives.
Signature:
Date:
Printed Name:
Title:
For a Municipal Advisory Firm:
I, the undersigned, have signed this Form MA-W on behalf of, and with the authority of, the municipal advisor withdrawing its registration. The advisor 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-W, including exhibits and any other information submitted, are true. I further certify that the municipal advisor’s books and records will be preserved and available for inspection as required by law, and that all information submitted on the municipal advisor ’s most recent Form MA is accurate and complete as of this date. The municipal advisor and I understand that if any information contained in this Form MA-W is different from the information contained on Form MA, the information on this Form MA-W will replace the corresponding entry on the municipal advisor ’s Form MA. Finally, I authorize any person having custodyor possession of these books and records to make them available to authorized regulatory representatives.
Signature:
Date:
Printed Name:
Title:
FORM MA-W: Schedule W1
Certain items in Form MA-W may require additional information on this Schedule W1. Use this Schedule W1 to report details for items listed below. Report only new information or changes/updates to previously submitted information. Do not repeat previously submitted information.
SECTION 6 Books and Records
Complete the following information for each person that has or will have custody or possession of any of the registrant's books and records. A separate Schedule W1 must be completed for each person . If the same person has or will have custody of any such books and records at more than one location, a separate Schedule W1 must be completed for this person for each such location.
Person with Custody:
- Name and business address of the person with custody or possession of books and records:
Name:
City:
State/Country:
Postal Code:
740-549-2702
Telephone Number:
Location of Books and Records:
Name of Location, if any:
City:
State/Country:
Postal Code:
740-549-2702
Telephone Number:
Data stored on encrypted and redundant hard drives