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Request for REAL ESTATE FINANCE Broker-Dealer Registration Status and Registration (RE) Number

New York State Office Of The Attorney General
Real Estate Finance Bureau

28 Liberty Street, 15^th Floor
New York. NY 10005
http://www.ag.ny.gov/bureau/real-estate-finance-bureau
REFBD@ag.ny.gov

Note: *Indicates Required Fields

Personal Information

Salutation

First Name *

Last Name *

Organization (if any)

Address *

Suite # or Floor # or Apt #

City or Town *

State *

Zip/Postal Code *

Phone (enter as xxx-xxx-xxxx)

Email *

I Hereby Request The Registration Filing Date For The Following Broker-Dealer:

1. Broker Dealer Info

Name of Registrant/Sponsor *

Name of Principal

Affiliated Plan Number *

Plan Name *

Plan Address *

City or Town *

State *

Zip/Postal Code *

Note: The RE number is required when submitting Form M-10 renewals and Forms M-3.

Would you like us to provide the registration (RE) number associated with this broker-dealer in our response? *

Yes

Do You Have A Second Broker Dealer Status Inquiry?

Yes

2. Broker Dealer Info

Name of Registrant/Sponsor *

Name of Principal

Affiliated Plan Number *

Plan Name *

Plan Address *

City or Town *

State *

Zip/Postal Code *

Note: The RE number is required when submitting Form M-10 renewals and Forms M-3.

Would you like us to provide the registration (RE) number associated with this broker-dealer in our response? *

Yes

Do You Have A Third Broker Dealer Status Inquiry?

Yes

3. Broker Dealer Info

Name of Registrant/Sponsor *

Name of Principal

Affiliated Plan Number *

Plan Name *

Plan Address *

City or Town *

State *

Zip/Postal Code *

Note: The RE number is required when submitting Form M-10 renewals and Forms M-3.

Would you like us to provide the registration (RE) number associated with this broker-dealer in our response? *

Yes

Do You Have A Fourth Broker Dealer Status Inquiry?

Yes

4. Broker Dealer Info

Name of Registrant/Sponsor *

Name of Principal

Affiliated Plan Number *

Plan Name *

Plan Address *

City or Town *

State *

Zip/Postal Code

Note: The RE number is required when submitting Form M-10 renewals and Forms M-3.

Would you like us to provide the registration (RE) number associated with this broker-dealer in our response? *

Yes

Do You Have A Fifth Broker Dealer Status Inquiry?

Yes

5. Broker Dealer Info

Name of Registrant/Sponsor *

Name of Principal

Affiliated Plan Number *

Plan Name *

Plan Address *

City or Town *

State *

Zip/Postal Code

Note: The RE number is required when submitting Form M-10 renewals and Forms M-3.

Would you like us to provide the registration (RE) number associated with this broker-dealer in our response? *

Yes

The Real Estate Finance Bureau will provide requestors with the date of filing of the M-10 or M-3. It will be the responsibility of the requester to calculate the expiration date of such registration in compliance with N.Y. Gen. Bus. Law § 359-(e). Requests will be responded to within ten business days.

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