Mail original form with all
signatures to Commission office
at the address below.
: (302) 744-4500
TELEPHONE
STATE OF DELAWARE
C
B
ANNON
UILDING
: (302) 739-2711
FAX
861 S
L
B
., S
203
ILVER
AKE
LVD
UITE
:
.
.
WEBSITE
DPR
DELAWARE
GOV
REAL ESTATE COMMISSION
D
, D
19904-2467
OVER
ELAWARE
EMAIL
customerservice.dpr@state.de.us
:
REQUEST FOR TRANSFER/INACTIVE STATUS/TERMINATION OR CANCELLATION OF LICENSE
1. Type of request (check one):
Request for Transfer - Complete Section A.
Request for Inactive Status - Complete Section B.
Request for Termination by Releasing Broker - Complete Section C.
Cancellation of License - Complete Section D.
2. Licensee Name: _____________________________________ License Number: R___- _____________
SECTION A: REQUEST FOR TRANSFER
REQUEST TO BE SIGNED BY TRANSFERRING LICENSEE
Transfer my license to the office of the undersigned Broker whose employ I will enter when the Commission Office
receives this request.
Are you the Broker of Record of the office you are leaving? Yes
No
If yes, enter the following about your replacement:
Name: ________________________________________________ License Number: R___ - ________________
Transferring Licensee Signature: _____________________________________________________ Date: _______________
Home Address: ______________________________________________ ________________________ __________ _________
Street
City
State
Zip
E-mail Address: __________________________________
STATEMENT TO BE SIGNED BY EMPLOYING BROKER OF RECORD
I request that the above licensee be transferred to my office.
Signature of Employing Broker: _______________________________________________________ Date: _______________
Printed Name of Employing Broker: _____________________________ Broker's DE License Number: R ___ - ______________
Agency Name: ________________________________________________ E-mail Address: _____________________________
Mailing Address: _________________________________________________________________________________________
________________________________________ ______________________________ __________________
City
State
Zip
STATEMENT TO BE SIGNED BY RELEASING BROKER OF RECORD
I release the above licensee from my office.
Signature of Releasing Broker: ________________________________________________________ Date: _______________
Printed Name of Releasing Broker: _____________________________ Broker's DE License Number: R ___ -_______________
Enclose $25.00 transfer fee.
IF you are transferring from an office outside Delaware to an office in Delaware, attach an original Certificate
of Licensure History.
Please destroy original license and pocket card.
REQUESTS NOT ACCOMPANIED BY THE REQUIRED FEE AND DOCUMENT WILL BE REJECTED.
Revised 6/2014
1
2
Form Rec 1.45 - Nonresident Supplement To The Application For Real Estate License - North Carolina Real Estate Commission
Legal
Form Rec 1.79 - Declaration Of Affiliation Of Limited Commercial License - North Carolina Real Estate Commission
Legal
