The statements below must be initialed by the Certificate Holder. In answering these questions, the Certificate Holder may exclude (and therefore initial “no”) to any juvenile proceedings, and traffic or similar nuisance offenses.
Previous to signing this InFRE Statement (or since the last Certificate Holder’s Statement): Yes No
I have been a defendant in a criminal proceeding that did not result in a conviction:
I have been convicted of a crime:
I have been a defendant in a regulatory or licensing proceeding brought by a state or federal agency, or civil/professional organization (FINRA, bar association, or similar professional organization) and the decision rendered was adverse to my interests:
I have been the subject of an inquiry or investigation with respect to my professional conduct by a state or federal agency, or civil/professional organization (FINRA, bar association, or similar professional organization):
For any “YES” answer, please explain the facts that determined the outcome of the referenced action:
