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Corporation Background Statement RE 212 - California

Corporation Background Statement Form. This is a California form and can be used in Licensing Bureau Of Real Estate Statewide .
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State of California Bureau of real eState Corporation BaCkground Statement RE 212 (Rev. 9/14) 1. Name of Director, officer, StockholDer, etc. (See iNformatioN above.) Read reverse side before completing. Background InformatIon 2. corporatioN Name 3. calbre corp. liceNSe iD# (if issued) 4. poSitioN/title with corporate liceNSe applicaNt 5. birth Date 6. withiN the laSt teN yearS, have you receiveD aN orDer or juDgmeNt iSSueD by a court or goverNmeNtal ageNcy temporarily or permaNeNtly reStraiNiNg or eNjoiNiNg aNy buSiNeSS coNDuct, practice, or employmeNt? yes Date of action No agency/court if yeS, complete the followiNg. case # aDDress explanation 7. withiN the laSt teN yearS, have you haD a buSiNeSS/profeSSioNal liceNSe to practice iN real eState or other regulateD profeSSioN, occupatioN, or vocatioN DeNieD, SuSpeNDeD, reStricteD, or revokeD iN califorNia or aNy other State? attach aDDitional sheets if necessary. yes type of license 8. No if yeS, complete the followiNg. license expiration Date license iDentification # state (issueD by) withiN the laSt teN yearS, have you coNDucteD activitieS iNvolviNg actS requiriNg a real eState liceNSe of aNy State without the beNefit of a valiD liceNSe or permit authoriziNg that coNDuct, which have beeN eNjoiNeD by a court of law or aDmiNiStrative tribuNal? yes No if yeS, complete the followiNg. case # arresting agency Date of conviction court of conviction coDe number violateD coDe section violateD Disposition 9. withiN the laSt teN yearS, have you beeN coNvicteD of aNy violatioN of law? (you may omit minor traffic citations which Do not constitute a misDemeanor or felony.) attach aDDitioNal SheetS if NeceSSary. yes No if yeS, complete the followiNg. "convicted" as used in this question includes a verdict of guilty by judge or jury, a plea of guilty or of nolo contendere or a forfeiture of bail. all convictions must be disclosed whether the plea or verdict was set aside and the charges against you dismissed or expunged under Section 1203.4 of the california penal code or if you have been pardoned. convictions occurring while you were a minor must be disclosed unless the record of conviction has been sealed under california penal code Section 1203.45 or Section 781 of the california welfare and institutions code. court of coNvictioN arreStiNg ageNcy Date of coNvictioN coDe Number violateD coDe SectioN violateD DiSpoSitioN i declare under penalty of perjury that the answers and statements given in this background statement are true and correct except where stated upon information and belief. You should review your application to insure it has been properly completed. failure to complete required portions of the application could result in either processing delays or denial of the license. 11. Date certIfIcatIon 10. SigNature of Director, chief executive officer, etc. American LegalNet, Inc. re 212 -- reverse InstructIons A separate RE 212 must be completed by each director, chief executive officer, president, first level vice presidents, secretary, chief financial officer, subordinate officers with responsibility for forming policy of the corporation and all natural persons owning or controlling more than ten percent of its shares who have an affirmative response to one or more of questions 6 through 9. Please type or print in ink. One individual per form. Reproduce as necessary. (Only legible photocopies are acceptable; however, signatures must be originals.) If you electronically re-create this form to facilitate completion on a computer, please be advised that the form should not be altered in any manner. To do so, could result in disciplinary action. Also, please make certain you do not delete any preprinted information and are using the latest version of the form. PRIVACY INFORMATION: Section 1798.17 of the Civil Code requires this notice be provided when collecting personal or confidential information from individuals. Each individual has the right to review personal information maintained by this Agency, unless access is exempted by law. Bureau of Real Estate Managing Deputy Comm. IV 1651 Exposition Blvd. Licensing, Examinations, & Education Sacramento, CA 95815 Telephone: 877-373-4542 General powers of the Commissioner, Sections 10050, 10071, and 10075 of the Business and Professions Code authorizes the maintenance of this information. Business and Professions Code Sections 30, 31(e) and 494.5(d) require each real estate licensee to initially provide to the Bureau of Real Estate his or her social security number which will be furnished to the Franchise Tax Board. The Franchise Tax Board will use your number Attach additional pages if more space is needed; each additional page must be appropriately numbered to correspond to the question being answered and signed by the applicant. Failure to provide complete answers to all of the following questions could result in either processing delays or denial of the license. Proof of Legal Presence Effective August 1, 1998, all applicants for a real estate salesperson, broker, or officer license, must submit proof that they have legal presence in the United States. A proof of legal presence document (i.e. birth certificate, resident alien card, etc.) must be submitted with a State Public Benefits Statement (RE 205) before a license will be issued. Please refer to that form for further instructions. to establish identification exclusively for tax purposes. These code sections also require that each application for a new license or renewal provides notification on the application, that the Board of Equalization and the Franchise Tax Board will share taxpayer information with the Bureau of Real Estate, and that failure to pay tax obligations may result in a suspension or denial of a license. The Board of Equalization and Franchise Tax Board require the Bureau to collect social security numbers and federal taxpayer identification numbers for the purposes of matching the names of the 500 largest tax delinquencies pursuant to Section 7063 or 19195 of the Revenue and Taxation Code. Your social security numbers and federal taxpayer identification number shall not be deemed public records and shall not be open to the public for inspection. The Real Estate Law and the Regulations of the Commissioner require applicants to provide the Bureau with specific information. If all or any part of the required information is not provided, processing may be delayed. In addition, the Commissione
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