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Corporation Change Application RE 204A - California

Corporation Change Application Form. This is a California form and can be used in Licensing Bureau Of Real Estate Statewide .
 Fillable pdf Last Modified 11/20/2014
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State of California Bureau of real eState Corporation Change appliCation RE 204A (Rev. 10/14) Received Date Corporation Changes Read instructions on page 3 before Mailing aDDRess Change completing this application. Main OffiCe aDDRess Change Type or print clearly in black or blue CORpORatiOn naMe aCtivatiOn ink. aDD/CanCel fiCtitiOus Business naMe DesignateD OffiCeR Indicate the type of change(s) by BroKer-oFFiCer Changes marking one or more boxes in the OffiCeR's peRsOnal naMe adjacent column. aCtivatiOn Of OffiCeR 1. CORpORatiOn iD nuMBeR corporation information 2. feDeRal taxpayeR iD nuMBeR (RequiRed-See PRivacy notice) calBrE USE onLY - eff. date of change 3. CORpORatiOn naMe -- pRint exaCtly as shOwn On liCense CeRtifiCate. corporation changES 4. new CORpORatiOn naMe, if Changing -- pRint as shOwn On aMenDeD aRtiCles Of inCORpORatiOn 5. CORpORatiOn Mailing aDDRess -- stReet aDDRess OR pOst OffiCe BOx, City, state, Zip CODe 6. CORpORatiOn Main OffiCe aDDRess -- stReet aDDRess, City, state, Zip CODe 7. fiCtitiOus Business naMe, if aDDing OR CanCeling -- pRint as it appeaRs On COunty CleRk's filing. add cancel add cancel tranSfEr "dESignatEd officEr" titLE to anothEr "LicEnSEd officEr" 8a. naMe Of CuRRent DesignateD OffiCeR CORpORate OffiCeR title, if ReMaining with CORp. 8B. CuRRent DesignateD OffiCeR -- CheCk One stateMent i am Remaining with the fiRm aS a licenSed officeR. 8C. signatuRe Of CuRRent DesignateD OffiCeR i am not Remaining with the fiRm aS a licenSed officeR. Date 8D. naMe Of new DesignateD OffiCeR 8e. liCense iD nuMBeR 8f. CORpORate OffiCeR title 8g. signatuRe Of new DesignateD OffiCeR 8h. Date LicEnSEd BrokEr-officEr changES 9. OffiCeR's naMe -- pRint as shOwn On liCense CeRtifiCate calBrE USE onLY 10. OffiCeR's new naMe, if Changing -- last, fiRst, MiDDle 11. DO yOu ResiDe in CalifORnia?.............................................................................................................................................................................. if nO, an "Re 234" May Be RequiReD. see page 3. 12. Business telephOne nuMBeR 13. ResiDenCe telephOne nuMBeR yes nO ( ( ) ) ( ) 14. Cell phOne nuMBeR 15. eMail aDDRess LicEnSEd BrokEr-officEr approvaL 16. signatuRe Of liCenseD BROkeR-OffiCeR Date calBrE USE onLY expiRatiOn Date flag CleaRanCe pROC. # Date pROCesseD Continued on reverse side American LegalNet, Inc. www.FormsWorkFlow.com RE 204A rEgULation 2746 Corporate Real Estate Brokers, Officers, Directors and Shareholders Page 2 of 3 (a) Atthetimeofapplicationfor,orinthereinstatementof,anoriginalrealestatebrokerlicense,thedesignatedofficershallfileabackground statementofinformationforeachdirector,thechiefexecutiveofficer,thepresident,firstlevelvicepresidents,secretary,chieffinancial officer,subordinateofficerswithresponsibilityforformingpolicyofthecorporationandallnaturalpersonsowningorcontrollingmore thantenpercentofitsshares,ifsuchpersonhasbeenthesubjectofanyofthefollowing: (1) Received an order or judgment issued by a court or governmental agency during the preceding 10 years temporarily or permanently restraining or enjoining any business conduct, practice or employment; (2) Has had a license to engage in or practice real estate or other regulated profession, occupation or vocation denied, suspended or revoked during the preceding 10 years; (3) Engagedinactsrequiringarealestatelicenseofanystatewithoutthebenefitofavalidlicenseorpermitauthorizingthat conductduringthepreceding10yearswhichhavebeenenjoinedbyacourtoflaworadministrativetribunal; (4) Beenconvictedofacrimewhichissubstantiallyrelatedtothequalifications,functionsordutiesofalicenseeoftheBureau asspecifiedinSection2910oftheseRegulations(excludingdrunkdriving,recklessdrivingandspeedingviolations). (b) The background statement shall be set forth in CalBRE Form 212 and shall inquire only about the information to be disclosed pursuant tosubdivision(a).Thebackgroundstatementmustbeverifiedandcompletedbyeachcorporateofficer,directororstockholderasnamed insubdivision(a)tothefullestextentofthesignatory'sactualknowledge. (c) WheneverthereisachangeinthepersonwhosebackgroundstatementsarerequiredtobeonfilewiththeBureauforacorporatelicensee pursuanttosubdivision(a)oranadditiontothepersonsrequiredtofilestatementspursuanttosubdivision(a),thedesignatedofficer ofthecorporationshall,within30daysthereafterfilewiththeBureauabackgroundstatementofinformationforeachneworchanged person. Note: Authoritycited:Section10080,BusinessandProfessionsCode.Reference:Section10152,BusinessandProfessionsCode. cErtification I certify that I have read and understand the provisions described above. (check one) IalsocertifythataCorporationBackgroundStatement(RE212)isnotneededforanyofficersorpersonsowningorcontrollingmore than ten percent of the corporation shares including myself. AcompletedCorporationBackgroundStatement(s)isattachedforeachofficer,directororshareholderwithareportableitemunder Regulation 2746. 17. CORpORate naMe 18. signatuRe Of OffiCeR appliCant (Must Be an ORiginal signatuRe) 19. Date American LegalNet, Inc. www.FormsWorkFlow.com RE 204A general information Readthefollowinginformationbeforecompletingthisapplication. If the newdesignatedofficerdoesnotcurrentlyhaveanofficer license for this corporation, a Corporation License Application (RE 201) must be submitted in addition to this form. Corporation Background Statement (RE 212) ­ Commissioner's Regulation2746requiresthedesignatedofficerwhoobtainsthe originalcorporationlicensetofileanRE212foranydirector,chief executiveofficer,president,firstlevelvicepresidents,secretary, chieffinancialofficerandsubordinateofficerswithresponsibility for forming policy of the corporation and all natural persons owningorcontrollingmorethantenpercentofitsshares,if such a person has been subject of any of the items enumerated in the regulation.Ifnoneoftheofficershavebeenasubjectofanyofthe items enumerated in the regulation, then an RE 212 is not needed. in all instances,thebroker-officermustcompleteandsignthe certificationonpage2ofthisapplication. Business and mailing addresses are public information and as such are posted on the Internet and available from CalBRE via telephoneandwrittenrequests.Pleaseconsiderthiswhenidentifying a license mailing address. If you electronically re-create this form to facilitate completion on a computer, 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 i
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