Form Re-620-170 - Application For Certification As A Real Estate Appraiser (Page 3 of 5) in pdf

Form Re-620-170 - Application For Certification As A Real Estate Appraiser Page 3

Educational requirements

An official college transcript or course certificate together with evidence of examination passage must be submitted for all

courses listed. Applicants must have successfully completed course work as specified in WAC's 308-125-030, 308-125-040,

308-125-045, and 308-125-050.

COURSE TITLE

DATES ATTENDED (Month/Year)

TOTAL CLASS ROOM HOURS/

COURSE SPONSOR

COURSE LOCATION

FROM

COLLEGE CREDITS (Qtr. or Sem.)

(City & State)

Certification/licensure in another state

List all licenses/certifications obtained in other states and indicate whether active or inactive.

STATE

DATE ISSUED (month and year)

NUMBER

ACTIVE/INACTIVE

EXPIRATION DATE (month and year)

Applicant attestation

I, the undersigned, certify that I am the person referred to in the foregoing application for licensure/certification as a real

estate appraiser in the state of Washington, that I have read and understand RCW 18.140 and WAC 308-125, and that

the statements herein are true to the best of my knowledge and belief.

I hereby authorize all organizations, my references, employers (past and present), business and professional associates

(past and present), and all governmental agencies and instrumentalities (local, state, federal or foreign) to release to the

Department of Licensing any information, files, or records requested by the department in connection with the processing

of this application.

I have carefully read the questions in the foregoing application and have answered them completely, without reservations

of any kind, and I declare under penalty of perjury that my answers and all statements made by me herein are true and

correct. Should I furnish any false information in this application, I hereby agree that such act shall constitute cause for

the denial, suspension, or revocation of my certification/license to practice as a certified/licensed real estate appraiser

in the state of Washington.

APPLICANT'S SIGNATURE

DATE

RE-620-170 RE APPRAISER APP. (R/1/99)M/W Page 3 of 5

Form Re-620-170 - Application For Certification As A Real Estate Appraiser Page 3