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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 Department Of Real Estate Statewide . |
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STATE OF CALIFORNIA DEPARTMENT OF REAL ESTATE Serving Californians Since 1917 CORPORATION CHANGE APPLICATION RE 204A (Rev. 6/09) 9 Read instructions on pages 3 and 4 before completing this application. 9 Type or print clearly in black or blue ink. 9 Indicate the type of change(s) by marking one or more boxes in the adjacent column. Received Date CORPORATION CHANGES MAILING ADDRESS CHANGE MAIN OFFICE ADDRESS CHANGE CORPORATION NAME ACTIVATION ADD/CANCEL FICTITIOUS BUSINESS NAME DESIGNATED OFFICER BROKER-OFFICER CHANGES OFFICER'S PERSONAL NAME ACTIVATION OF OFFICER 1. CORPORATION ID# CORPORATION INFORMATION DRE USE ONLY -- EFF. DATE OF CHANGE 2. CORPORATION NAME -- PRINT EXACTLY AS SHOWN ON LICENSE CERTIFICATE. 3. NEW CORPORATION NAME, IF CHANGING -- PRINT AS SHOWN ON AMENDED ARTICLES OF INCORPORATION CORPORATION CHANGES 4. CORPORATION MAILING ADDRESS -- STREET ADDRESS OR POST OFFICE BOX, CITY, STATE, ZIP CODE 5. CORPORATION MAIN OFFICE ADDRESS -- STREET ADDRESS, CITY, STATE, ZIP CODE 6. 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" CORPORATE OFFICER TITLE, IF REMAINING WITH CORP. 7A. NAME OF CURRENT DESIGNATED OFFICER 7B. CURRENT DESIGNATED OFFICER -- CHECK ONE STATEMENT I AM REMAINING WITH THE FIRM AS A LICENSED OFFICER. 7C. SIGNATURE OF CURRENT DESIGNATED OFFICER I AM NOT REMAINING WITH THE FIRM AS A LICENSED OFFICER. DATE ¾ 7D. NAME OF NEW DESIGNATED OFFICER 7E. CORPORATE OFFICER TITLE 7F. SIGNATURE OF NEW DESIGNATED OFFICER ¾ DATE LICENSED BROKER-OFFICER CHANGES 8. OFFICER'S NAME -- PRINT AS SHOWN ON LICENSE CERTIFICATE OFFICER'S NEW NAME, IF CHANGING -- LAST, FIRST, MIDDLE DRE USE ONLY 9. 10. DO YOU RESIDE IN CALIFORNIA?............................................................................................................................................ IF NO, AN "RE 234" MAY BE REQUIRED. SEE PAGE 3. 11. BUSINESS TELEPHONE NUMBER (INCLUDE AREA CODE) YES NO 12. RESIDENCE TELEPHONE NUMBER (INCLUDE AREA CODE) LICENSED BROKER-OFFICER APPROVAL 13. SIGNATURE OF LICENSED BROKER-OFFICER ¾ DATE DRE 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 4 (a) At the time of application for, or in the reinstatement of, an original real estate broker license, the designated officer shall file a background statement of information for each director, the chief executive officer, the 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, if such person has been the subject of any of the following: (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) Engaged in acts requiring a real estate license of any state without the benefit of a valid license or permit authorizing that conduct during the preceding 10 years which have been enjoined by a court of law or administrative tribunal; (4) Been convicted of a crime which is substantially related to the qualifications, functions or duties of a licensee of the Department as specified in Section 2910 of these Regulations (excluding drunk driving, reckless driving and speeding violations). (b) The background statement shall be set forth in DRE Form 212 and shall inquire only about the information to be disclosed pursuant to subdivision (a). The background statement must be verified and completed by each corporate officer, director or stockholder as named in subdivision (a) to the fullest extent of the signatory's actual knowledge. (c) Whenever there is a change in the person whose background statements are required to be on file with the Department for a corporate licensee pursuant to subdivision (a) or an addition to the persons required to file statements pursuant to subdivision (a), the designated officer of the corporation shall, within 30 days thereafter file with the Department a background statement of information for each new or changed person. Note: Authority cited: Section 10080, Business and Professions Code. Reference: Section 10152, Business and Professions Code. CERTIFICATION I certify that I have read and understand the provisions described above. (check one) I also certify that a Corporation Background Statement (RE 212) is not needed for any officers or persons owning or controlling more than ten percent of the corporation shares including myself. A completed Corporation Background Statement(s) is attached for each officer, director or shareholder with a reportable item under Regulation 2746. 14. CORPORATE NAME 15. » SIGNATURE OF OFFICER APPLICANT 16. DATE American LegalNet, Inc. www.FormsWorkFlow.com RE 204A Page 3 of 4 General Information 9 Read the following information before completing this application. 9 If the new designated officer does not currently have an officer license for this corporation, a Corporation License Application (RE 201) must be submitted in addition to this form. 9 Corporation Background Statement (RE 212) Commissioner's Regulation 2746 requires the designated officer who obtains the original corporation license to file an RE 212 for any director, chief executive officer, president, first level vice presidents, secretary, chief financial officer and subordinate officers with responsibility for forming policy of the corporation and all natural persons owning or controlling more than ten percent of its shares, IF such a person has been subject of any of the items enumerated in the regulation. If none of the officers have been a subject of any of the items enumerated in the regulation, then an RE 212 is not needed. In all instances, the broker-officer must complete and sign the certification on page 2 of this application. 9 Business and mailing addresses are public information and as such are posted on the Internet and available from DRE via telephone and written requests. Please con
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