Idaho Department of Finance

RENEWAL OF MUTUAL FUND OR UNIT INVESTMENT TRUST

State File/Notice No.  
Name of Issuer/Fund:  
Previous Name (If changed):
Portfolio:
Previous Portfolio Name (if changed):
Type of Filing:
Contact Person:
Name:  
Firm:  
Mailing Address:   City:  
State:  Zip:   Telephone:  Fax:
To which email address would you like the form summary be sent:    
The Renewal Fee is $300 for Mutual Funds and $100 for Unit Investment Trusts. You will have an opportunity to pay online after submitting this renewal.
By affixing my name to this application I, ,  hereby certify, that I have executed this Uniform Investment Company notice on behalf of, and with the authority of the issuer. I and the issuer represent that the information and statements contained in the notice filed, are current, true and complete to the best of my knowledge, information and belief and that any documents submitted with the notice are true copies of the originals, and that the securities covered by this Notice are Covered Securities as defined by Section 18(b)(2) of the Securities Act of 1933.

By affixing my name, date of birth, and mother's maiden name, and submitting this application electronically, I understand that I am as fully responsible for the contents herein as though I had signed and submitted this application manually.
Dated this
Name:  
Date of Birth:  
Mother's Maiden Name:  
Title:
Address:
City State: Zip