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Corporation License Application RE 201 - California

Corporation License Application Form. This is a California form and can be used in Licensing Bureau Of Real Estate Statewide .
 Fillable pdf Last Modified 7/17/2013
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State of California Bureau of real eState Real Estate MATTERS! Corporation LiCense appLiCation RE 201 (Rev. 7/13) BRE usE only BRE REcEivEd datE BRE usE only GEnERal infoRmation This application may be used to license: A corporation with a designated broker-officer, An additional broker-officer with a new or currently A new officer as a substitute (replacement) for the licensed corporation, OR existing designated broker-officer. Read Sections III and IV before completing this application. This application must be completed and signed by the brokerofficer applicant. A Certificate of Status or Articles of Incorporation and the Any changes (addresses, DBA, etc.) to a currently licensed corporation must be submitted on a Corporation Change Application (RE 204A). bre use only appropriate fee must accompany this form. Refer to Section IV. sEction i -- coRpoRation infoRmation 1A. Does this corporAtion currently holD or hAs it previously helD A reAl estAte license in cAliforniA? no yes if yes, complete items 1b AnD 1c. 1c. expirAtion DAte 1b. broKer iDentificAtion number 2A. corporAtion nAme (print nAme As it AppeArs on certificAte of stAtus, Do not list fictitious business nAmes.) 2b. cAliforniA secretAry of stAte iDentificAtion number (refer to pAge 4) 2c. feDerAl tAxpAyer iDentificAtion number (requireD-see privAcy notice) 3A. mAiling ADDress (street ADDress or post office box) 3b. city 3c. stAte 3D. Zip coDe 4A. mAin office ADDress (street ADDress - must be A physicAl ADDress) 4b. city 4c. stAte ca 4D. Zip coDe 5. fictitious business nAme (if Any) ­ AttAch A copy of the fictitious business nAme stAtement As fileD with the county clerK. sEction ii -- BRokER-officER infoRmation 1A. Do you currently holD or hAve you previously helD A reAl estAte license in cAliforniA? no yes if yes, complete items 1b -1D. 1c. type of license 1D. expirAtion DAte of license 1b. license iDentificAtion number 2. nAme of broKer-officer (lAst, first & miDDle) 3. sociAl security number (REquiREd-see privAcy notice) 4. birth DAte (mm/DD/yyyy) 5. corporAte officer title 6. type of broKer-officer license requesteD: (checK one) refer to fee section on pAge 4. DesignAteD broKer-officer ADDitionAl broKer-officer (Refer to fees.) (943) substitution of current DesignAteD broKer-officer (Refer to page 4, section ii instructions, #6.) If yes, form re 866 must be submItted to the bureau wIthIn 30 days of performIng the actIvIty. see filing instructions on bre web site. 7. upon becoming licenseD, will the corporAtion, for compensAtion, mAKe, ArrAnge, or service resiDentiAl mortgAge loAns (1-4 units)? no yes 8. upon becoming licenseD, will the corporAtion, for compensAtion, tAKe ApplicAtions, negotiAte, or offer to negotiAte resiDentiAl mortgAge loAns (1-4 units)? (944) no yes If yes, a mortgage Loan orIgInator LIcense must aLso be obtaIned. see instructions on bre web site. BRE usE only restricteD license corporAtion officer cleArAnce rec'D DoJ fbi exAm iD number fingerprints receiveD not neeDeD rAp rec'D DoJ fbi processor # & DAte processeD license effective DAte license expirAtion DAte notes flAg cleArAnce violAtions American LegalNet, Inc. www.FormsWorkFlow.com RE 201 sEction ii -- BRokER-officER infoRmation (continuEd) 9. Do you resiDe in the stAte of cAliforniA? Page 2 of 5 no yes ( ( ) ) if no, then A consent to service of process (re 234) must Also be completeD. (refer to #8 instruction on page 4.) 11. resiDence telephone number - requireD 10. business telephone number (Do not list fAx numbers.) - requireD ( ) 12. cell phone number - requireD 13. emAil ADDress 14. hAve you ever useD Any other nAmes (i.e., mAiDen nAme, AKA, etc.)? no yes 15. height if yes, list nAmes useD. 16. weight 17. color of eyes 18. color of hAir 19. genDer mAle femAle BackGRound infoRmation carefully read and provide detailed answers to questions 20-26. you must provide a "yes" or "no" response to all questions, and also completely and accurately provide the detailed information required in item(s) 27 and 28 below. Attach additional sheets if you need more space. failure to disclose pertinent information may result in denial of your license application and/or delays. 20. hAve you ever been convicteD of Any violAtion of the lAw? All stAte AnD feDerAl misDemeAnor AnD felony convictions, AnD All militAry AnD foreign convictions, must be DiscloseD. convictions expungeD unDer penAl coDe section 1203.4 or A similAr stAtute must still be DiscloseD. if yEs, complEtE itEm 27................................................. 21. Are there criminAl chArges penDing AgAinst you At this time? if yEs, complEtE itEm 27....................................................... 22. hAve you ever hAD A DenieD, suspenDeD, restricteD or revoKeD business or professionAl license (incluDing reAl estAte), in cAliforniA or Any other stAte? if yEs, complEtE itEm 28..................................................................................... 23. Are there Any license DisciplinAry Actions penDing AgAinst A business or professionAl license you holD At this time? if yEs, complEtE itEm 28. ......................................................................................................................................................................... 24. hAve you ever been requireD to register As A sex offenDer pursuAnt to the provisions of section 290 of the cAliforniA penAl coDe or Any compArAble lAw of Any stAte or governmentAl unit? if yEs, complEtE itEm 29........... 25. hAve you ever been orDereD to ceAse, Desist AnD/or refrAin from Doing An Act(s), or from violAting A lAw, rule or regulAtion by, or citeD for A breAch of ethics or unprofessionAl conDuct, by An ADministrAtive Agency or professionAl AssociAtion in cAliforniA or Any other stAte? if yEs, complEtE itEm 29........................................................... 26. hAve you ever pleD guilty to or entereD A pleA of nolo contenDere or A no contest pleA to Any violAtion of lAw in A stAte, militAry, or feDerAl court? if yEs, complEtE itEm 29............................................................................................... yes yes yes yes yes yes yes no no no no no no no conviction dEtails "convicted" as used in item 20 includes a verdict of guilty by judge or jury, a plea of guilty, a plea of nolo contendere (i.e., "no contest"), or a forfeiture of bail in the courts (including military courts) of any state, commonwealth, possession or country. All convictions must be disclosed, no
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