Re 212 - Corporation Background Statement Page 2
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1
2re 212 — reverse
InStructIonS
A separate RE 212 must be completed by each director,
Attach additional pages if more space is needed; each
chief executive officer, president, first level vice presidents,
additional page must be appropriately numbered to
secretary, chief financial officer, subordinate officers with
correspond to the question being answered and signed
responsibility for forming policy of the corporation and
by the applicant.
all natural persons owning or controlling more than ten
Failure to provide complete answers to all of the following
percent of its shares who have an affirmative response to
questions could result in either processing delays or
one or more of questions 6 through 9.
denial of the license.
Please type or print in ink.
One individual per form. Reproduce as necessary. (Only
legible photocopies are acceptable; however, signatures
must be originals.)
If you electronically re-create this form to facilitate
completion on a computer, please be advised that the form
should not be altered in any manner. To do so, could result
in disciplinary action. Also, please make certain you do
not delete any preprinted information and are using the
latest version of the form.
PRIVACY INFORMATION:
sections also require that each application for a new license or renewal
license, or in the case of a license applicant, may deny the issuance for
Section 1798.17 of the Civil Code requires this notice be provided when
provides notification on the application, that the Board of Equalization
misstatements of facts (including a failure to disclose a material fact) in
collecting personal or confidential information from individuals. Each
and the Franchise Tax Board will share taxpayer information with
an application for a license.
individual has the right to review personal information maintained by this
the Bureau of Real Estate, and that failure to pay tax obligations may
The information requested in this form is primarily used to furnish license
Agency, unless access is exempted by law.
result in a suspension or denial of a license. The Board of Equalization
status information to the Bureau’s Enforcement Section, and to answer
Bureau of Real Estate
Managing Deputy Comm. IV
and Franchise Tax Board require the Bureau to collect social security
inquiries and give information to the public on license status, mailing and
1651 Exposition Blvd.
Licensing, Examinations, & Education
numbers and federal taxpayer identification numbers for the purposes
business addresses and actions taken to deny, revoke, restrict or suspend
Sacramento, CA 95815
Telephone: 877-373-4542
of matching the names of the 500 largest tax delinquencies pursuant
licenses for cause.
General powers of the Commissioner, Sections 10050, 10071, and 10075
to Section 7063 or 19195 of the Revenue and Taxation Code. Your
This information may be transferred to real estate licensing agencies
of the Business and Professions Code authorizes the maintenance of this
social security numbers and federal taxpayer identification number shall
in other states, law enforcement agencies (City Police, Sheriff’s
information.
not be deemed public records and shall not be open to the public for
Departments, District Attorneys, Attorney General, F.B.I.), and any
Business and Professions Code Sections 30, 31(e) and 494.5(d) require
inspection.
other regulatory agencies (i.e., Department of Business Oversight,
each real estate licensee to initially provide to the Bureau of Real
The Real Estate Law and the Regulations of the Commissioner require
Department of Insurance, Department of Consumer Affairs, California
Estate his or her social security number which will be furnished to the
applicants to provide the Bureau with specific information. If all or
Bar Association).
Franchise Tax Board. The Franchise Tax Board will use your number
any part of the required information is not provided, processing may
to establish identification exclusively for tax purposes. These code
be delayed. In addition, the Commissioner may suspend or revoke a
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