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IDAHO REAL ESTATE APPRAISER BOARD

Bureau of Occupational Licenses

Owyhee Plaza

1109 Main Street, Suite 220

Boise, ID 83702

(208) 334-3233

APPLICATION FOR TEMPORARY PRACTICE PERMIT

General Instructions: Please complete this application and the Consent to Service of Process form, attach the required $100.00

fee and mail to the address above. Certified proof of licensure or certification must be received directly from your state of

licensure before your application will be processed.

1. Full Name (Mr., Mrs., or Ms.) ___________________________________________________________________________

2. Mailing Address_______________________________________________________________________________________

Street/PO Box

City

State

Zip

3. Date of Birth ______/______/______ Place of Birth___________________ Social Security No. _______/______/______

YYYY

4. Daytime phone _(____)______________ Fax _(____)______________

E-mail ________________________________

5. Please list the type of License or Certification held and number ______________________________________________

(This office must receive official certification of said licensure directly from the licensing or certifying authority before your

application will be processed.)

6. Please describe the Appraisal Assignment for which the permit will be used:

________________________________________________________________________________________________________

7. Projected Beginning Date: ____________________

Projected Ending Date: ____________________

(Note: Applicant must furnish information sufficient to identify the appraisal assignment, but shall not be required to divulge any

information concerning the appraisal assignment which would breach the applicant’s duty of confidentiality under the provisions

of USPAP)

CONSENT TO SERVICE OF PROCESS and AFFIDAVIT

Know all persons by these presents:

Pursuant to the requirements of Chapter 41, Title 54, of the Idaho Code, I hereby irrevocably consent, stipulate and agree

that suits, actions and administrative proceedings may be commenced against me in the courts and agencies of this State, by the

service of any process authorized by the laws of this State on the Chief of the Bureau of Occupational Licenses, and that service of

such process upon said Chief shall be taken and held in all courts to be as valid and binding as if the service had been made upon

me in the State of Idaho. I hereby certify under oath that the responses provided above and those attached to this application are

true and accurate to the best of my knowledge and belief. I further certify that I have reviewed and will comply with the Idaho

Laws and Rules governing Real Estate Appraiser practice. I hereby authorize and direct any person, agency, firm, or other entity to

release, upon the request of the Bureau of Occupational Licenses or it’s authorized representative, any information, report,

communication, record, statement, recommendation, or disclosure that may have bearing on my eligibility for or maintenance of

the license for which I am applying. I understand that by signing this form I am authorizing the release of information about me

that may otherwise be protected or confidential.

______________________________________________________

Signature of Applicant

State of ______________, County of _________________, ss.

Subscribed and sworn before me this ______ day of _______________________, 20 _____.

______________________________________________________

(seal)

Notary Public official signature

residing at___________________________________________

my commission expires_________________________________

REA-TMP 4.0 - revised 07/20/99

Application For Temporary Practice Permit Form - Idaho Bureau Of Occupational Licenses

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