Consent To Examine And Audit Special Accounts Form printable pdf download

Consent To Examine And Audit Special Accounts Form

Important Notice:

Completion of this form is

necessary

accomplish

the

requirements

CONSENT TO EXAMINE AND AUDIT SPECIAL ACCOUNTS

outlined

[225

ILCS

455/1-455/38.65].

Disclosure of this information is REQUIRED.

Failure to comply may result in this form not

Office of Banks and Real Estate

being processed. This form has been approved

500 East Monroe, Suite 200

by Forms Management.

Springfield, IL 62701

Real Estate Licensing 217/782-3414

I have one or more special accounts, and authorize a representative of Office of Banks and Real Estate to examine those accounts.

(Please complete both Parts A and B of this form.)

I do not accept escrow monies, and do not hold monies belonging to others. Therefore, I do not maintain any special accounts.

(Please complete only Part A of this form.)

PART A: BROKER INFORMATION

1. Name of Individual Broker, Partnership, Corporation, or Limited Liability Company

2. Business Address (Street, City, State, Zip Code)

3. Telephone Number ( _ _ _ ) _ _ _ - _ _ _ _

4. License Number

PART B:DEPOSITORY AT WHICH REAL ESTATE SPECIAL ACCOUNT(S) ARE MAINTAINED. A separate Consent to Audit form is

required for each depository at which you maintain special account(s). Copy this form as needed.

1. Name and address of Bank or Savings and Loan Association

2. Specific Special Accounts to be Examined and Audited

Title(s) of Special Account(s)

Account Number

Identifying Number(s)

Required by IRS

(FEIN or Social Security No.)

3. List Those Persons Authorized to Withdraw Funds From the Above-Named Special Account

Sex

Name

Title

License Number

I hereby authorize the above named-depository to allow, at any time, a duly authorized representative of the Office of Banks and Real Estate to

examine and audit the above named special account(s). I am one of the individuals listed under Part B(3) above.

Signature of Managing Broker

License Number

Date

Title

500 EAST MONROE STREET • SPRINGFIELD, ILLINOIS • 62701-1509 • PHONE: 217-785-9300 • FAX: 217-782-3390 • TDD: 217-524-6644

Consent To Examine And Audit Special Accounts Form

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