Request For Transfer/inactive Status/termination Or Cancellation Of License Form - Delaware Real Estate Commission Page 2

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SECTION B: REQUEST FOR INACTIVE STATUS
You must renew Inactive status by April 30 of even years.
To reactivate to Active status, you must complete continuing education accrued during inactive period.
REQUEST TO BE SIGNED BY REQUESTING LICENSEE
Place my license on Inactive Status through April 30 of the current period.
Licensee Signature: ______________________________________________________ Date: _____________
Home Address: ___________________________________________ _____________________ __________ _________
Street
City
State
Zip
E-mail Address: __________________________________
STATEMENT TO BE SIGNED BY RELEASING BROKER OF RECORD
I release the above licensee from my office to inactive status.
Signature of Releasing Broker: ___________________________________________________ Date: _______________
Printed Name of Broker: ___________________________________ Broker's DE License Number: R ___ - ____________
Agency Name: ____________________________________________ E-mail Address: ____________________________
Enclose $40.00 inactive license fee.
Please destroy original license and pocket card.
REQUESTS NOT ACCOMPANIED BY THE REQUIRED FEE WILL BE REJECTED.
SECTION C: REQUEST FOR TERMINATION BY RELEASING BROKER
I release the above licensee from my office to be terminated.
Termination Date: _____________________
Signature of Releasing Broker: ___________________________________________________ Date: _______________
Printed Name of Broker: __________________________________ Broker's DE License Number: R ___ - _____________
Agency Name: _____________________________________________ E-mail Address: ___________________________
Mailing Address: ______________________________________ ________________________ ___________ _________
Street
City
State
Zip
Licensee Home Address: _______________________________ _______________________ ___________ _________
Street
City
State
Zip
Please destroy original license and pocket card. NO FEE REQUIRED
SECTION D: CANCELLATION OF LICENSE BY LICENSEE
I request cancellation of my above referenced license.
Licensee Signature: _______________________________________________ Date: _______________
Home Address: __________________________________________ _______________________ ________ __________
Street
City
State
Zip
Please destroy original license and pocket card. NO FEE REQUIRED
Revised 6/2014

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