State Board Of Certified Real Estate Appraisers Form 2013
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270 AMC-ADD/NAME 10/13
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Mailing Address:
Courier Address:
Telephone: 717-783-4866
State Board of Certified Real
State Board of Certified Real
Fax: 717-705-5540
Estate Appraisers
Estate Appaisers
E-mail:
st-appraise@state.pa.us
PO Box 2649
2601 North Third Street
Website:
Harrisburg, PA 17105-2649
Harrisburg, PA 17110
APPRAISAL MANAGEMENT COMPANY CHANGE OF NAME AND/OR ADDRESS APPLICATION
CHECK THE APPROPRIATE BLOCK(S) AND COMPLETE THE REQUESTED INFORMATION
CHANGE OF NAME:
Submit your approved documentation from the Pennsylvania Bureau of Corporations and Charitable
Organizations
•
Foreign corporation submit - Amended Certificate of Authority
•
Domestic corporation submit – Articles of Amendment
•
Domestic Limited Liability Company submit – Amendment To A Certificate of Organization
•
Foreign Limited Liability Company submit – Amendment To The Foreign Registration
CHANGE OF ADDRESS:
Complete the information below
REQUEST FOR A DUPLICATE LICENSE:
If you would like a new printed registration, submit a $5.00 fee, check or money order, payable to the
“Commonwealth of PA.” A processing fee of $20.00 will be charged for any check or money order returned
unpaid by your bank, regardless of the reason for non-payment.
SECTION 1: APPLICANT INFORMATION
PLEASE PRINT OR TYPE
FORMER NAME:
REGISTRATION NUMBER:
NEW NAME:
MAILING ADDRESS:
STREET
CITY
STATE
ZIP
EMAIL ADDRESS:
CONTACT NUMBERS:
TELEPHONE______________________
FAX_____________________________
HAVE THERE BEEN ANY
YES__________________________
NO______________________________
CHANGES IN OWNERSHIP
OR KEY PERSONS SINCE
INITIAL REGISTRATION?
HAVE ALL CHANGES IN
YES______________________________
NO_______________________________
OWNERSHIP AND KEY
PERSON BEEN
IF NO, SUBMIT CHANGE OF
PREVIOUSLY REPORTED
OWNERSHIP OR CHANGE OF KEY
TO THE BOARD?
PERSON APPLICATION
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