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Form 08-4076a - Broker Notice To Real Estate Commission Of Licensee Termination Form - Department Of Commerce And Economic Development

REC

STATE OF ALASKA

FOR OFFICE USE ONLY

DEPARTMENT OF COMMERCE AND ECONOMIC DEVELOPMENT

DIVISION OF OCCUPATIONAL LICENSING

REAL ESTATE COMMISSION

3601 C STREET, SUITE 722

ANCHORAGE, ALASKA 99503-5986

(907) 269-8162

E-mail: License@commerce.state.ak.us

BROKER NOTICE

TO REAL ESTATE COMMISSION

OF LICENSEE TERMINATION

Attached is the signed/dated license for

(Name of Licensee)

License Number:

who is being terminated from

(Name of Office)

. Licensee was affiliated with the above-named office from

“ Transferring to another office

. Reason for Termination:

“ Inactivating license

“ Unable to locate licensee

“ Disciplinary Action by broker (attach explanation)

“ Other (attach explanation)

I understand that I am responsible for listings and transactions that have been generated by this licensee and which are

still pending.

I further understand that no transactions submitted by this licensee and dated later than the above date will be attributed

to my office or subject to my supervision.

(Signature of Broker)

(Printed Name of Broker)

Date

(Broker Number)

BROKER:

Please sign and date license certificate, attach to this notice, and mail both items to the

Commission office immediately after signing. The individual licensee is respon-sible

for completing any status change application form and paying the appropriate fee.

08-4076a (Rev. 6/98)

GO/dgl

Form 08-4076a - Broker Notice To Real Estate Commission Of Licensee Termination Form - Department Of Commerce And Economic Development