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City: <br /> Rose an <br /> Statelcountry: INEWJERSEY �- <br /> Postal Code: <br /> For non-US telephone and fax <br /> numbers,include country code with <br /> area code and local number. <br /> Telephone Number: 973-818-9500 <br /> Fax Number: 973-sie-95ot - - <br /> E-mail Address of Chief Compliance kmcmanus@altemativereg,com <br /> Officer.- <br /> H. Contact Person <br /> If a person other than the Chief Compliance Officer is authorized to receive Information and respond to questions about this form,provide the name and <br /> contact Information for that person: <br /> Please note that the applicant must provide name and contact information for either a Chief Compliance Officer in Question 1.G„or another contact <br /> person in Question 1.H below.Both may be provided. <br /> Enter all the letters of each name and not initials or other abbreviations.If no middle name,enter NMN on that line. <br /> Last Name: Pickett <br /> _..__.._ _ -- . <br /> First Name: <br /> Jeff <br /> Middle Name: lRobert J <br /> Other title(s),if any: Principal <br /> Street Address 1: 11470 M__.-.�..-�-ART LANE <br /> Street <br /> - i <br /> Street Address 2: SUITE 315 <br /> City: JRL UT CREEK A <br /> State/Country: <br /> Postal Code: <br /> For non-US telephone and fax <br /> numbers,include country code with <br /> area code and local number. <br /> Telephone Number: 25-478-7450 <br /> Fax Number: 25 478-7697 <br /> E-mail Address of Contact Person: left@isoma visors com <br /> I. Location of Books and Records <br /> (1)Does the applicant maintain,or Q Yes No <br /> intend to maintain,some or all of the <br /> books and records required to be kept <br /> under MSRB rules and SEC rules at a <br /> location other than the principal office <br /> and place of business address listed in <br /> Item 1-E? <br /> (2)If"Yes,"fist all such locations in <br /> Section 1-I of Schedule D. <br /> J. Foreign Financial Regulatory Authorities <br /> t1)Is the applicant registered with a Yes J No <br /> (foreign financial regulatory authority? <br /> Answer"no"even if affiliated with a <br /> business that is registered with a <br /> foreign financial regulatory authority. <br /> F)If"Yes,"list all such registrations in <br /> e)ctlon 1-J of S-hedule-D. <br /> K. Business Affiliates of the applicant <br />