State Form 46355 - Application For Real Estate Trainee Appraiser Examination/licensure - 2003 Page 2
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1
2Have you ever been denied a residential appraiser license, certified residential appraiser license, or certified general appraiser license by this state or any other state?
(If Yes, provide a copy of the license denial.)
Yes
No
Have you had a residential appraiser license, certified residential appraiser license, or certified general appraiser license suspended or revoked by any other state?
(If Yes, provide a copy of the licensing board order.)
Yes
No
Have you ever been convicted of a crime? (If Yes, provide a copy of the court order and any pertinent documents.)
Yes
No
NOTARY CERTIFICATE
STATE OF
}
SS:
COUNTY OF
I,
, having been duly sworn on oath, say that I am the
above-named applicant, that I have personally prepared the foregoing application, and that the same is true to the best of my knowledge and belief.
Signature of applicant
Signature of Notary Public
Printed or typed name of applicant
Printed or typed name of Notary Public
Date subscribed and sworn to Notary Public
County of residence
Date commission expires
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