Certification Form Of Legal Presence
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1CERTIFICATION OF LEGAL PRESENCE
FOR UTAH REAL ESTATE, MORTGAGE, APPRAISER, AND TIMESHARE
APPLICANTS
APPLICANTS PLEASE NOTE:
This document must be completed, signed, and submitted with your application to the Utah
Department of Commerce in order to obtain your license. For each section, check the statement
that applies to you and enter the data on the line provided before sending it to the Utah
Department of Commerce.
Industry/Type: Appraiser Appraiser Trainee
Mortgage Real Estate
Timeshare
License or NMLS number: _____________________
Social Security Number: _______________________________________________________
I certify under penalty of perjury that:
□
I am a citizen of the United States and I have a valid US Drivers License or US State ID.
License/State ID Number: ___________________
State: _____________________
□
I am a citizen of the United States and do not have a valid US Drivers License or US State
ID. Please attach a legible copy of your valid passport or other documentation to verify
you are a legal citizen of the United States.
□
I am a non-citizen of the United States, who is lawfully present in the United States and I
have a valid US Drivers License or US State ID.
License/State ID Number: ___________________
State: _____________________
□
I am a non-citizen of the United States, who is lawfully present in the United States and I
do not have a valid US Driver License or US State ID. Please attach a legible copy of your
current and valid government issued document showing evidence of authorization to work
in the United States.
I hereby certify that I have read and understood this document, and that the information I have
provided is true and accurate.
Name: __________________________________________
Signature: _______________________________________
Date: ___________________________________________
Fax to: 801-526-4387 or Email to: realestate@utah.gov
Rev 3/3/2014
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