Appraiser Permit Application Form
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1
2
3WYOMING CERTIFIED REAL ESTATE APPRAISER BOARD
Office Use Only
2020 CAREY AVE., SUITE 100
CHEYENNE, WYOMING 82002
Lic. No. ___________________
(307) 777-7141
Issued _____________________
APPRAISER PERMIT APPLICATION
RESIDENTIAL/GENERAL PERMIT FEE
TRAINEE PERMIT FEE
Application Fee:
$450.00
Application Fee:
$450.00
Education Fund:
$ 20.00
Education Fund:
$ 20.00
TOTAL 3 years
$470.00
Federal Filing Fee:
$ 75.00
TOTAL 3 years
$545.00
PLEASE TYPE OR PRINT LEGIBLY
07/00
TYPE OF CERTIFICATION APPLYING FOR:
( ) General
( ) Residential
( ) Trainee
NAME:_______________________________________________________________________________________________
Last
First
Middle Initial
DATE OF BIRTH: ________________________________
SOCIAL SECURITY NO: ___________________________
FIRM NAME: __________________________________________________________________________________________
BUSINESS ADDRESS: __________________________________________________________________________________
Street
City
State
Zip Code
FIRM MAILING ADDRESS: ______________________________________________________________________________
Street/Box Number
City
State
Zip Code
BUSINESS PHONE NO: _______________________ FAX NO: ______________________ E-MAIL: __________________
HOME MAILING ADDRESS: _____________________________________________________________________________
Street/Box Number
City
State
Zip Code
HOME PHONE NO: _________________________
**CITIZENSHIP: ___U.S. ___ OTHER ATTACH COPY OF BIRTH CERTIFICATE (FEDERAL LAW REQUIRES PROOF OF LEGAL
PRESENCE IN U.S. FOR PERMITTEES.) SEE ATTACHED LIST A AND B.
If you answer Αyes≅ to any of the following three questions, you must submit a written explanation and official
documentation as attachments to your application:
1. Have you ever entered a plea of nolo contendere, been found guilty of, or been Αconvicted≅ of a felony?
Yes ________
No ________
2. Have you or any partnership or corporation in which you were a legal or financial participant ever been
disciplined, sanctioned, or fined AND/OR had a license, permit, certificate or registration suspended, revoked,
surrendered or resigned by the board or agency issuing the license, permit, certificate, or registration?
Yes ________
No ________
3. Have you ever had an application for a real estate appraiser license, permit, or certification been denied?
Yes ________
No ________
Indicate each state in which you have been licensed, current and/or expired.
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