Termination Of Sponsorship Of A Salesperson Or Associate Broker - Louisiana Real Estate Commission

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CLEAR FORM
LOUISIANA REAL ESTATE COMMISSION
Post Office Box 14785
Baton Rouge, LA 70898-4785
(800) 821-4529 (LA only) or (225) 925-1923
Fax (225) 925-4501
TERMINATION OF SPONSORSHIP OF A SALESPERSON OR ASSOCIATE BROKER
This form must be returned to the LREC within five (5) working days following the date
the form is signed.
The signature of the terminating party is the only signature required below.
Submission of this document with a single signature shall require submission of proof that
the other party has been notified of the termination via registered or certified mail sent by
the terminating party to the address on file with the Louisiana Real Estate Commission.
Addresses can be found using the Licensee Search at
.
Proof of notification shall not be required if this document contains the signature of both the
sponsored licensee and the sponsoring broker.
1. Name of Sponsored Licensee:
(Type or Print)
License Number of Sponsored Licensee:
2. Name of Sponsoring Broker:
(Type or Print)
License Number of Sponsoring Broker:
3. Sponsorship is being terminated at the request of the:
□
Sponsored licensee
□
Sponsoring broker
Signature of Sponsored Licensee/Date:
______________________________________
Signature of Sponsoring Broker/Date:
______________________________________
TOS Form Rev. 08/2012

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