REAL ESTATE CORPORATION/PARTNERSHIP INFORMATION FORM 78 – 79
Office of Banks and Real Estate
500 E Monroe Street, Suite 200
Real Estate Licensing 217/782-3414
Important Notice: Completion of this form is necessary to accomplish the requirements outlined in [Illinois Real Estate Act of 2000]. Disclosure of this
information is REQUIRED. Failure to comply may result in this form not being processed. This form has been approved by Forms Management.
V V PARTNERSHIP
V V CORPORATION
V V LIMITED PARTNERSHIP
TYPE OF FIRM:
Company Name
Date of Organization
FEIN Number
Address(Street, City, State, Zip Code)
Telephone Number
( _ _ _ ) _ _ _ - _ _ _ __
Name of Managing Broker
Managing Broker License Number
Firm License Number (If Applicable)
Name of Principal Filing Application
Business Address of the Registering Principal (Street, City,
State, Zip Code )
List All Officers, Directors, General Partners and All Limited Partners
Name
Illinois Real Estate
Title(indicate officer,
Illinois Business Address(Street, City,
License Number
director, gen. partner)
State, Zip Code )
List All Persons and/or Entities having an Ownership Interest in Excess of 10 Percent
Name/Entity
Illinois Real Estate
Percent of
Illinois Business Address (Street, City,
License Number
Ownership
State, Zip Code )
I hereby certify that I personally completed this form, that the information is true and correct, to the best of my knowledge and belief, and that
I am a principal of the above-named company in Illinois. I further certify that each principal not licensed in the State of Illinois is not actively
participating in the brokerage business as defined in the Illinois Real Estate License Act of 2000, Sec. 5(15).
Signature of Applicant
_
I hereby certify that that the answers appearing hereon are true and correct to the best of my knowledge and belief, and that I am legally
authorized to sign for this firm.
Signature of Managing Broker______________________________________________________
Date ________________
IL 505-0336 (Revised 7/2000)