Active Status Request Form 2000
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WYOMING REAL ESTATE COMMISSION
2020 CAREY AVE, SUITE 100
CHEYENNE WYOMING 82002-0180
(307) 777-7141
ACTIVE STATUS REQUEST
Effective this date, please place my inactive Wyoming Real Estate license on an active status.
$20 FEE IS ENCLOSED
TO BE COMPLETED IF YOU ARE TO BE SPONSORED BY A BROKER
Have you been convicted or pleaded nolo contendere to a felony or are any such charges pending at this time?
____Yes
____No
If yes, attach explanation.
I hereby authorize the Wyoming Real Estate Commission to release all records and files pertaining to my professional
licensure to my sponsoring broker.
DATE:__________________________
(SIGNED)____________________________________________________
(Home Address)_______________________________________________________________________________________
TO BE COMPLETED BY SPONSORING BROKER
I, ____________________________________________________, am the real estate broker sponsoring the above named
licensee and it is my opinion that said licensee is honest, truthful and of a good reputation and that he/she is competent to
transact the business of a real estate agent in such a manner as to safeguard the interests of the public; and I, therefore,
recommend that said license be granted. I further certify that I will actively supervise the licensee during the period the
licensee is under my sponsorship and the requested license remains in effect.
DATE:_________________________________ (SIGNED)___________________________________________________
(FIRM NAME)______________________________________________________________________________________
TO BE COMPLETED IF YOU ARE A BROKER OPENING YOUR OWN OFFICE
TRADE NAME_________________________________________________________________________________________
BUSINESS ADDRESS & PHONE NO.______________________________________________________________________
HOME ADDRESS______________________________________________________________________________________
TELEPHONE______________________ FAX___________________________ E-MAIL______________________________
MY OFFICE COMPLIES WITH LOCAL ZONING REGULATIONS
( ) YES
( ) NO
A SIGN IS CONSPICUOUSLY DISPLAYED ON THE PREMISES
( ) YES
( ) NO
NAME, NUMBER AND LOCATION OF WYOMING TRUST ACCOUNT:___________________________________________
(Attach Voided Deposit Slip)
Have you been convicted or pleaded nolo contendere to a felony or are any such charges pending at this time?
____Yes
____No
If yes, attach explanation.
DATE:__________________________
(SIGNED)_________________________________________________
NOTE: If you plan to do business as a corporation, LLC or partnership, you will also have to make application for a
corporation, LLC or partnership license.
If you are establishing an office in your home, a letter from your local zoning office is required showing approval.
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