Asi Form 6609-05 - Dual License Application Page 2
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1
2DISTRICT OF COLUMBIA
REAL ESTATE BOARD
DUAL LICENSE APPLICATION
(ASI Form 6609-05)
4.
SCREENING QUESTION – The following questions must be completed by all applicants. If you answer “YES” to any questions below, provide a
complete explanation on a separate sheet of paper.
YES
NO
Have you (or if company, any officer of the company) been arrested, indicted or convicted of a
A.
crime (other than minor traffic violations) since your last renewal?
ASI ONLY O
YES
NO
Has any state denied your application for a license, or taken disciplinary action against your
license since your last renewal?
B.
ASI ONLY O
5.
SPONSORING BROKER’ S STATEMENT – To be completed by the broker who employs or will employ the Principal Broker, Associate Broker or
Property Manager applicant.
This license will have the following role in the company:
Associate Broker
Principal Broker
Property Manager
__________________________________________________________________
COMPANY NAME
____________________________________
____________________________________
COMPANY LICENSE NUMBER
COMPANY FEIN
I have read this application in full. In my opinion, ____________________________________________, the applicant, is honest, truthful,
and of good reputation, and I recommend that the license be granted.
_____________________________________________________
_____________________________________________
PRINCIPAL BROKER’ S SIGNATURE
DATE
6. AFFADAVIT OF APPLICANT— This form will be returned unprocessed if the form if not signed by the applicant and notarized. Keep a photocopy of this
form for your records.
I, _________________________________________________________, being duly sworn, depose and say: That the
information given in this application, including all writing and exhibits attached hereto, is true and complete.
___________________________________________________
__________________
APPLICANTS SIGNATURE
DATE
ASI ONLY O
State: _____________________________
Subscribed and sworn to before me this ___________ day of _______________________(month), ___________(year)
by the affiant, who personally appeared before me.
______________________________________________
_______________________________
(SEAL)
NOTARY PUBLIC SIGNATURE
MY BOARD EXPIRES
_________________________
ASI ONLY
Clerk’ s Initials _________
_________________________
Rev. 11/13/00
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