Form Re-620-029 - Application For Broker Address Change - 2000
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1Real Estate Licensing
APPLICATION FOR
PO Box 9021
BROKER ADDRESS CHANGE
Olympia, WA 98507-9021
(360) 753-2262
BRANCH OFFICE ADDRESS CHANGE
FAX (360) 586-0998
Spokane Office (509) 921-2362
please print or type
Fee: ................. $26.50
Make remittance payable to: STATE TREASURER
Company information
If application information is incomplete, the applicaiton will not be processed.
Firm Name
New Address (Number and Street)
PO Box
Telephone Number
City
State
Zip
County
Previous Address (Number and Street AND PO Box)
City
State
Zip
County
*
Designated Broker's Name (First, Middle, Last)
Designated Broker's Social Security Number
Designated Broker's Residence Mailing Address
Designated Broker's Residence Phone Number
City
State
Zip
County
*
State law, RCW 26.23.150, requires you to furnish your Social Security Number when you apply for this license. If this application
is for a business that is a sole proprietorship, the proprietor must furnish his/her Social Security Number. Resident aliens, without a
Social Security Number, must furnish their Individual Tax Identification Number.
Designated Broker, please reply to the following questions:
1. Is new business properly zoned for a real estate office?
____ Yes
____ No
2. What is zoning of new office location?_____________________________________
3. Will you maintain and manage a real estate office that is accessible to the public
____ Yes
____ No
4. Are you currently required to register as a sex offender in this state or any other state? ____ Yes
____ No
If yes, state _______ county _______
X
Broker's Signature
Broker's License No.
THIS BLOCK FOR OFFICE USE ONLY
LB
20
26.50
1
PROG 1
TRAN 3
PROF 4
PIC NO. 4
BILLED 16
SPLIT 43
Change of address procedures
Please submit the following:
1. Completed application (above) for Broker Address Change, Branch Office Address Change. This application must be
completed by the designated broker of the company.
2. Applications (Application for Real Estate License, form number RE-620-004) for all salespersons and associate
brokers affected by the change.
3. A $26.50 fee for each application.
4. Return all real estate licenses showing the previous address.
5. If you wish to add, delete, or change a PO Box or suite number, the requirements apply.
If you have any questions, please contact this office at one of the numbers above.
The Department of Licensing has a policy of providing equal access to its services. If
you need special accommodation, please call (360)753-2262 or TTY (360)753-1966.
RE-620-029 BROKER/BRANCH ADD CHANGE (R4/00)FM/W
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