Form SEC2198 Form N-17f-2

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
OMB APPROVAL
OMB Number:
3235-0360
Expires: December 31, 2014
Estimated average burden
hours per response. . . . . . . 2.0

FORM N-17f-2
Certificate of Accounting of Securities and Similar
Investments in the Custody of
Management Investment Companies
Pursuant to Rule 17f-2 [17 CFR 270.17f-2]
1. Investment Company Act File Number:

Date examination completed:

8112. State identification Number:
AL

AK

AZ

AR

CA

CO

CT

DE

DC

FL

GA

HI

ID

IL

IN

IA

KS

KY

LA

ME

MD

MA

MI

MN

MS

MO

MT

NE

NV

NH

NJ

NM

NY

NC

ND

OH

OK

OR

PA

RI

SC

SD

TN

TX

UT

VT

VA

WA

WV

WI

WY

PUERTO RICO

Other (specify):
3. Exact name of investment company as specified in registration statement:

4. Address of principal executive office (number, street, city, state, zip code):

INSTRUCTIONS
This Form must be completed by investment companies that have custody of securities or similar investments.
Investment Company
1.

All items must be completed by the investment company.

2.

Give this Form to the independent public accountant who, in compliance with Rule 17f-2 under the Act and applicable state law, examines
securities and similar investments in the custody of the investment company.

Accountant
3.

Submit this Form to the Securities and Exchange Commission and appropriate state securities administrators when filing the certificate of
accounting required by Rule 17f-2 under the Act and applicable state law. File the original and one copy with the Securities and Exchange
Commission’s principal office in Washington, D.C., one copy with the regional office for the region in which the investment company’s
principal business operations are conducted, and one copy with the appropriate state administrator(s), if applicable.

THIS FORM MUST BE GIVEN TO YOUR INDEPENDENT PUBLIC ACCOUNTANT

SEC 2198 (04-09)

SECís Collection of Information
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently
valid OMB control number. Filing of Form N-17f-2 is mandatory for an investment company that has custody of securities or similar
investments. Rule 17f-2 under section 17(f) of the Investment Company Act of 1940 requires the investment company to retain an independent
public accountant to verify the companyís securities and similar investments by actual examination three times during each fiscal year. The
accountant must prepare a certificate stating that the examination has occurred and describing the examination, and must transmit the certificate
to the Commission with Form N-17f-2 as a cover sheet. The Commission uses the Form to ensure that the certificate is properly attributed to
the investment company. The Commission estimates that the burden of completing Form N-17f-2 is approximately 1.0 hours per filing. Any
member of the public may direct to the Commission any comments concerning the accuracy of the burden estimate of this Form, and any
suggestions for reducing this burden. This collection of information has been reviewed by the Office of Management and Budget in accordance
with the clearance requirements of 44 U.S.C. ß 3507. Responses to this collection of information will not be kept confidential.

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