Application For 2nd And/or Temporary Real Estate Broker'S License Form

ORIGINAL LICENSE FEE:

For license issued between 10/1/1999 and 9/30/2000-----$45.00

Separate E & O Insurance Coverage is

For license issued between 10/1/2000 and 9/30/2001---- $90.00

required for each additional Broker’ s license

STATE OF ALABAMA REAL ESTATE COMMISSION

1201 CARMICHAEL WAY

MONTGOMERY, ALABAMA 36106

APPLICATION FOR 2ND AND/OR TEMPORARY REAL ESTATE BROKER’ S LICENSE

(NOTE: Please print all answers in ink or use typewriter)

(Mr.)

1. Name: (Mrs.)______________________________________________License Number:___________________

(Miss)

(State Full Name)

2. Residence Address:______________________________________City:______________Zip:_______________

3. Home Phone: _______________________________________________________________________________

Are you a citizen of the United States?___________Naturalization Certificate No:____________________

4. Presently Employed By:_________________________________________Phone:_________________________

5. Company name in which you will operate: (new name)______________________________________________

Address:____________________________________________________________________________________

Note: This address must be the same as No. 4 above

(Street & No., City, State & Zip)

County:________________Qualifying Broker’ s Name_______________________________________________

6. Is the new company name in which you will operate that of: (Please check one)

Individually owned company______ Partnership______Corporation_______

7. Are you the owner of the new company?___________If not, give name of owner:__________________________

8. If you are not the sole owner of both companies, you must have consent of all officers of both partnerships, corporations, or

individually owned companies to operate as a broker in the name of both companies.

Consent is hereby given for_______________________________to be licensed as a broker to operate

(Name of Applicant)

doing business in below listed partnerships, corporations or individually owned companies.

Please sign on appropriate lines:

______________________________

______________________________ ____________________________________

(Signature of officer of corporation #1) (Signature of officer of corporation #1)

(Signature of officer of corporation #1)

_____________________________

______________________________ ____________________________________

(Signature of officer of corporation #2 (Signature of officer of corporation #2

(Signature of officer of corporation #2)

_______________________________ ______________________________

____________________________________

(Signature of partner of partnership #1 (Signature of partner of partnership #1)

(Signature of partner of partnership #1)

_______________________________ _____________________________

___________________________________

(Signature of partner of partnership #2 (Signature of partner of partnership #2

(Signature of partner of partnership #2)

___________________

______________________________________

(Signatures of owner of both individually owned companies)

9. I hereby accept the responsibility for the actions covered by the Alabama Real Estate License Law of any and all salesmen

licensed under me or any corporation or partnership for whom I am the qualifying broker, as set out in Section 5, and all other

provisions of the Alabama Real Estate License Law pertaining and relating thereto.

AFFIDAVIT

STATE OF ALABAMA

CITY OF___________________________

COUNTY OF_______________________

______________________________________, being duly sworn, deposes and says he/she has read the herein application and the

answers thereon noted, that such answers are true to his/her knowledge except as to any matter therein stated to be alleged

upon information and belief and that as to such matter he/she believes it to be true, and the he/she has personally attached

signature to this affidavit.

Signed _______________________________________ (This signature must be identical with name shown on No. 1 above).

(Signature of Applicant)

Sworn to and subscribed before me this the _____________day of______________________,19____,

_________________________________________________

NOTARY PUBLIC

Application For 2nd And/or Temporary Real Estate Broker'S License Form - 1999-2000

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