Ohio > Statewide > Department Of Commerce > Real Estate > Broker
Multiple License Transfer Reactivation Affidavit COM 3683 - Ohio
| Multiple License Transfer Reactivation Affidavit Form. This is a Ohio form and can be used in Broker Real Estate Department Of Commerce Statewide . |
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Please visit our website at www.com.ohio.gov/real 614 | 466-4100 Fax 614 | 644-0584 TTY/TDD: 800 | 750-0750 MULTIPLE LICENSE TRANSFER/REACTIVATION AFFIDAVIT This affidavit shall be used when the license of more than one broker, salesperson, or branch office is being transferred or when the license of more than one broker, salesperson, or branch office is being reactivated from a Sole-Broker suspension. ATTENTION: Effective 7/01/2010, the signatures of all brokers and salespeople affected by a transfer must be obtained and submitted with this form. Signatures are not required for reactivations. Return all five pages of the affidavit to the Division. TRANSFER Please complete and submit all five pages of the affidavit. Mark N/A on any pages that do not apply. Transfer Fee Structure: $25 for each broker, $25 for each salesperson, and $15 for each branch office, not to exceed $6,000. Return the company license and addendum. I, ________________________________, make the following affirmations based upon personal knowledge: (Print Broker Name) 1. That each licensee whose name and license number is listed in Attachment A or Attachment B has been informed that his/her license will be transferred from ____________________________ to ____________________________ (Current Brokerage) (Date of Transfer) (New Brokerage) on or about ____________________________ and has consented as indicated by their signature contained herein. 2. Or, if he/she does not consent to said transfer, that the name and license number of those licensees who have not consented to such transfer are listed in Attachment C. 3. That any affected branch office is listed in Attachment D. 4. That ____________________________ holds the Division harmless for any error or omission occurring in (New Brokerage) connection with the transfer of the licenses listed in Attachment A or Attachment B. Broker Signature: ____________________________ Broker File #: ________________ PLEASE NOTE: BROKERS AND SALESPEOPLE AFFECTED BY THE TRANSFER MUST SIGN PAGE TWO OR THREE OF THIS AFFIDAVIT. COMPLETE THE FOLLOWING BROKERS (Attachment A) SALESPEOPLE (Attachment B) BRANCH OFFICES (Attachment D) TOTAL LICENSES @ $25.00 @ $25.00 @ $15.00 TOTAL FEE FOR ALL TRANSACTIONS TOTAL FEES $ $ $ $ REACTIVATION - Please complete and submit all five pages of the affidavit. Mark N/A on any page that does not apply. Penalty and reactivation fees apply only to the broker. There is no charge to reactivate salespeople, branch offices, or companies from a Sole-Broker suspension. Return all affected licenses including the company or sole-broker license, all salesperson licenses, and any branch office licenses. I, ________________________________, make the following affirmations based upon personal knowledge: 1. That each licensee whose name and license number is listed in Attachment A or Attachment B has been informed that his/her license will be reactivated to ___________________________ and has consented to such reactivation. (New Brokerage) (Print Broker Name) 2. Or, if he/she does not consent to said reactivation, that the name and license number of those licensees who have not consented to such reactivation are listed in Attachment C. 3. That any affected branch office is listed in Attachment D. 4. That ____________________________ holds the Division harmless for any error or omission occurring in (New Brokerage) connection with the reactivation of the licenses listed in Attachment A or Attachment B. Reactivation Date:__________ Broker Signature: ______________________ Broker File #: ____________ COM 6383 (Rev. 07/2010) NOTICE: Refusal of check payment by the drawer's bank may result in a one-hundred-dollar fee payable to the superintendent or rejection or withdrawal of approval of this application. NOTICE: This application and the information contained therein, except for social security numbers, is public record pursuant to Ohio Revised Code 149.43. "An Equal Opportunity Employer and Service Provider" Page 1 of 5 American LegalNet, Inc. www.FormsWorkFlow.com ATTENTION TRANSFERRING BROKER: BY SIGNING THIS PAGE, YOU ARE CONSENTING TO THE TRANSFER DESCRIBED ON PAGE ONE OF THIS AFFIDAVIT. ATTACHMENT A - BROKERS FEE: $25 PER BROKER OLD FILE NUMBER NEW FILE NUMBER (FOR TRANSFERS ONLY) NEW PHONE NEW FAX OLD BROKERAGE NAME NEW BROKERAGE NAME (FOR TRANSFERS ONLY) NEW BROKERAGE ADDRESS (FOR TRANSFERS ONLY) CITY COUNTY ( FILE NUMBER PRINT FULL NAME OF BROKER ) STATE ( ) ZIP CODE + 4 BROKER'S SIGNATURE (FOR TRANSFERS ONLY) TRANSFER THESE TOTALS TO THE TABLE ON PAGE 1. Attach additional pages as needed. TOTAL NUMBER OF BROKERS LICENSES TOTAL BROKER TRANSFER FEES $ Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com ATTENTION TRANSFERRING SALESPERSON: BY SIGNING THIS PAGE, YOU ARE CONSENTING TO THE TRANSFER DESCRIBED ON PAGE ONE OF THIS AFFIDAVIT. ATTACHMENT B - SALESPERSON FEE: $25 per salesperson OLD FILE NUMBER NEW FILE NUMBER (FOR TRANSFERS ONLY) NEW PHONE NEW FAX OLD BROKERAGE NAME NEW BROKERAGE NAME (FOR TRANSFERS ONLY) NEW BROKERAGE ADDRESS (FOR TRANSFERS ONLY) CITY COUNTY ( FILE NUMBER PRINT FULL NAME OF SALESPERSON ) STATE ( ) ZIP CODE + 4 SALESPERSON'S SIGNATURE (FOR TRANSFERS ONLY) TRANSFER THESE TOTALS TO THE TABLE ON PAGE 1. Attach additional pages as needed. TOTAL NUMBER OF SALESPERSON LICENSES TOTAL SALESPERSON TRANSFER FEES $ Page 3 of 5 American LegalNet, Inc. www.FormsWorkFlow.com THE LICENSEES LISTED BELOW DO NOT CONSENT TO TRANSFER. ATTACHMENT C NOT CONSENTED OLD FILE NUMBER NEW FILE NUMBER (FOR TRANSFERS ONLY) NEW PHONE NEW FAX OLD BROKERAGE NAME NEW BROKERAGE NAME (FOR TRANSFERS ONLY) NEW BROKERAGE ADDRESS (FOR TRANSFERS ONLY) CITY COUNTY ( FULL NAME OF LICENSEE LICENSE TYPE BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON BROKER SALESPERSON ) STATE ( ) ZIP CODE + 4 LICENSE NUMBER Attach additional pages as needed. Page 4 of 5 American LegalNet, Inc. www.FormsWorkFlow.com ATTACHMENT D BRANCH OFFICES FEE: $15 per branch OLD BROKERAGE NAME NEW BROKERAGE NAME (FOR TRANSFERS ONLY) NEW BROKERAGE ADDRESS (FOR TRANSFERS ONLY
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