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exemption in MI 31-102 this form is required to be delivered to the regulator in paper format. 1. Individual Name of individual: NRD number of individual: 2. Business location Address of business location: NRD number of business location: 3. Termination Effective date of termination: Indicate whether the individual: • was dismissed for cause • was dismissed in good standing • resigned in good standing • is deceased Include details regarding any: • unresolved client co.

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