Form 6-Re - Application For Renewal Of Broker'S License Page 2

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1. If you own or operate a sole proprietorship, partnership, association, corporation, limited liability company or any other business

association in real estate, you need to list the firm name and/or trade name(s), address and answer questions 2 and 3.

Firm and/or Trade Name(s):________________________________________________________________________________

___________________________________________________________________________________________

Physical Address: ________________________________________________________________________________________

Mailing Address: _________________________________________________________________________________________

ALL OF THE FOLLOWING QUESTIONS MUST BE ANSWERED WITH A YES OR NO ANSWER.

2. Is this trade name, sole proprietorship, partnership, association, corporation, limited liability company or any other business

association registered and in Good Standing with the New Hampshire Secretary of State? ________________________________

Forms may be obtained to register with the Secretary of State at

3. Is this trade name, sole proprietorship, partnership, association, corporation, Limited Liability Company or any other business

association licensed with New Hampshire Real Estate Commission? _________________________________________________

*4. Have you, since your last original or renewal application, been through bankruptcy or insolvency or made a compromise with your

creditors? _________________

*5. Are there any undischarged court judgments or liens against you at this time? _________________________________________

*6. Have you, since your last original or renewal application, been convicted of a misdemeanor or felony offense? _________ If "yes", contact this

office at (603) 271-4127 for an Arrest and Conviction Form or you may obtain the form from the Commission web site at

estate-commission/index.htm

under the licensing section.

*7. Have you, since your last original or renewal application, been or are now involved in any matters which may affect your good

repute or trustworthiness or have any relation to or bearing upon whether you are entitled to public confidence? _______________

*8. Have any licenses which you have held to sell real estate been subject to disciplinary action in any state since your last original or

renewal application? ______________________

* IF YOU ANSWERED “YES” TO QUESTIONS 4, 5, 6, 7 OR 8, ATTACH A SEPARATE SHEET OF PAPER TO THIS APPLICATION GIVING

FULL DETAILS AND AN EXPLANATION.

Your license will expire two years from the date of issue and failure to renew such license will automatically cause your license to expire. If your

license expires, you may reinstate your license up to six months from the expiration date by submitting the required documents and renewal fee plus

a late renewal penalty fee. If you fail to renew within the six month period, your license will lapse, and you will have to meet all the qualifications of a

new candidate. However, the Commission may renew a lapsed license within a reasonable time from the date of lapse for good cause shown as

required by RSA 331-A:18, II.

The following statement applies to principal broker applicants only:

As a principal broker, pursuant to RSA 331-A:13,V, I hereby give permission to the Real Estate Commission to audit the escrow account or

accounts. I attest that I have read the foregoing statement and affixed my signature below.

________________________________________

SIGNATURE OF PRINCIPAL BROKER APPLICANT ONLY

* *

* * All Applicants Must Provide A Notarized Signature Below *

* *

_______________________________________________________________

Signature of Applicant