SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
APPLICATION FOR MUNICIPAL ADVISOR REGISTRATION FOR NATURAL PERSONS
OMB Number: 3235-0681
Estimated average burden hours per response: 3.0
Form MA-I Applicant's Information
Submission Contact Information
Notification Information
Notification will automatically be sent to the Login CIK, Submission Contact, and Primary Issuers. Specify additional addresses below.
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
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 
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
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.
YES 
NO (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.)
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.
YES NO YES NO (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:
Located At Supervised From 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
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
YES NO YES NO Prior to the Above
Prior employment history must be entered in reverse chronological order.
Prior Address
YES NO YES NO Prior Address
YES NO YES NO Prior Address
YES NO YES NO Item 5 Other Business
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:
YES NO YES NO (2) Based upon activities that occurred while the individual exercised control over it, has an organization ever:
YES NO 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 YES NO 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.
YES NO Item 6G.
Has the individual been notified, in writing, that he or she is currently the subject of any:
YES NO INVESTIGATION DISCLOSURE
If the answer is "Yes" to Item 6G(2) below, complete an Investigation DRP.
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:
YES NO YES NO YES NO 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: YES NO YES NO YES NO YES NO 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:
YES NO YES NO YES NO FINANCIAL DISCLOSURE
Item 6K.
Within the past 10 years:
YES NO YES NO YES NO Item 6L.
YES NO JUDGMENT/LIEN DISCLOSURE
If the answer is "Yes" to any question below in Item 6M, complete a Judgment/Lien DRP.
Item 6M.
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.
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.
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.
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.