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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 .
 Fillable pdf Last Modified 1/5/2016
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STATE OF CALIFORNIA BUREAU OF REAL ESTATE CORPORATION BACKGROUND STATEMENT RE 212 (Rev. 1/16) 1. NAME OF DIRECTOR, OFFICER, STOCKHOLDER, ETC. (SEE REVERSE.) 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 No IF YES, COMPLETE THE FOLLOWING. LICENSE EXPIRATION DATE LICENSE IDENTIFICATION # STATE (ISSUED BY) 8. 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 "Convicted" as used in question 9 below includes: Convictions expunged under Penal Code sections 1203.4, 1203.4a and 1203.41 or equivalent non-California statute must still be disclosed. Proof that a conviction has been expunged under Penal Code sections 1203.4, 1203.4a and 1203.41 must be submitted with the application. Exceptions to "Convicted": DO NOT DISCLOSE AFTER 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. ARRESTING AGENCY DATE OF CONVICTION COURT OF CONVICTION CODE NUMBER VIOLATED CODE SECTION VIOLATED DISPOSITION CERTIFICATION 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. American LegalNet, Inc. www.FormsWorkFlow.com RE 212 -- Reverse INSTRUCTIONS A separate RE 212 must be completed by each director, Failure to provide complete answers to all of the following questions could result in either processing delays or denial of the license. Please type or print in ink. PRIVACY INFORMATION: American LegalNet, Inc. www.FormsWorkFlow.com
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