Form 47330 - Application For License Activation - Indiana Professional Licensing Agency

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*SOCIAL SECURITY NUMBER
APPLICATION FOR LICENSE ACTIVATION
This State agency is requesting disclosure of
State Form 47330 (R2 / 11-02)
your Social Security number under IC 4-1-8-1
in order to perform its statutory function. Dis-
Approved by State Board of Accounts, 2002
closure is mandatory.
APPLICANT
In order to reactivate an inactive license during a two (2) year licensure period, the licensee must obtain the six (6) hours of continuing
INFORMATION:
education required by IC 25-34.1-9-11 (1) for that two (2) year licensure period and pay a ten dollar ($10) fee. The ten (10) elective hours
must be shown at the end of the renewal period. You may complete the entire sixteen (16) hours.
INSTRUCTIONS: 1. Complete Sections A and B to activate license with a broker.
2. Complete Section A to reactivate without a broker.
3. Submit fee of $10.00.
4.
All fees are nonrefundable and nontransferable
Attach proof of six (6) core hours, or sixteen (16) hours of continuing education.
5.
6.
Send to:
Indiana Professional Licensing Agency
302 W. Washington St., Rm. E034
FOR BROKER ACTIVATION
Indianapolis, IN 46204
CHECK ONLY IF APPLICABLE
T elephone: (317) 232-2980
WILL HOLD MY OWN LICENSE
Salesperson Activation
Broker Activation
Referrals Only
SECTION A
APPLICANT INFORMATION
Name of applicant
License number
Residential address (number and street)
T elephone number
(
)
Date (month, day, year)
City, state, ZIP code
*Social Security number
Signature of applicant
SECTION B
SALESPERSON'S OR BROKER'S REQUESTED REASSIGNMENT
The licensed broker for the State of Indiana named below requests the license of the Salesperson/Broker to be reassigned to the
requesting broker with full responsibility for Salesperson's/Broker's actions in real estate transactions while in Broker's Association.
Date (month, day, year)
Name of requesting broker
Name of company
IB No. only ____________________ or
CO No. _______________________
Address (number and street)
Requesting broker's residential address (number and street)
City, state, ZIP code
T elephone number
City, state, ZIP code
(
)
*Requesting broker's Social Security number
Signature of requesting broker
OFFICE USE ONLY
AB - Associate Broker (broker working for another broker)
NOTE: Licenses cannot be assigned to an Associate Broker.
IB - Independent Broker (broker NOT working for another broker)

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