Initial Broker License Application Form - Louisiana Real Estate Commission (Page 2 of 2) in pdf

CERTIFICATION AND ACKNOWLEDGMENT

I attest that I have knowledge of and understand the provisions of the Fair Housing Act of 1968, the Louisiana Equal

Housing Opportunity Act, and any amendments thereto, and that I will neither induce nor attempt to induce any

person to sell or rent any dwelling by representation regarding the entry or prospective entry into an area,

subdivision or neighborhood of a person or persons of a particular race, color, religion or national origin. I hereby

acknowledge the forfeiture of all fees filed with my application for a Louisiana real estate license in the event that I

do not obtain the license for which I have applied. Further, if this application is acted upon favorably, I agree to

comply with all the laws embodied in Title 37, Chapter 17, Louisiana Revised Statutes of 1950, and amendatory

acts, and the Rules and Regulations of the Louisiana Real Estate Commission. I hereby certify that all the

information provided in this application is true and correct and the Louisiana Real Estate Commission may rely on

its truthfulness in considering this application.

________________________________________

_______________________

Signature of Applicant

Date

State of _________________________

Parish/County____________________

BE IT KNOWN, That before me, the undersigned authority personally appeared _________________,

well known to me, who did declare and acknowledge that _____ signed the foregoing instrument for the

objects and purposes therein, expressed, and said applicant herein being duly sworn by me, Notary,

deposed and said that all and singular the facts set forth in the foregoing application are true and correct.

SWORN TO and subscribed before me, Notary, on this the _____ day of _______________, 20_______.

_____________________________________

Notary Public

IMPORTANT NOTICE: Broker applicants who intend to become franchisees of a national franchise

organization should thoroughly review Chapters 19 and 25 of the Commission Rules and Regulations in

order to ensure compliance with advertising and trade name registration requirements.

SPONSORING BROKER ACKNOWLEDGMENT:

_________________________________________ _________________________________________

Sponsoring Broker Signature

Name of Company

SPONSORING BROKER SIGNATURE REQUIRED ONLY IF APPLYING AS AN ASSOCIATE BROKER.

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Initial Broker License Application Form - Louisiana Real Estate Commission Page 2