Form Re-620-008 - Real Estate Individual Broker'S License Application - 2006
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1Real Estate Individual Broker's
License Application
REAL ESTATE LICENSING
P.O. BOX 9048
FOR VALIDATION ONLY
OLYMPIA, WA 98507-9048
(360) 664-6488 or (360) 664-6500
Click Here to Start, Then Tab From Field to Field
FAX (360) 586-0998
dol.wa.gov
See page 2 for instructions and requirements
Please check the appropriate box(es):
First License
$210.00
Make remittance payable to State Treasurer.
New Individual Broker Office $210.00
Send application with your remittance to:
Change of Address
No Fee
Department of Licensing
PO Box 9048
Company Name Change
No Fee
Olympia, WA 98507-9048
Applicant Information
If application information is incomplete, it will not be processed.
*
Applicant's Name (Last, First, Middle)
Social Security No.
Date of Birth
DBA Name (if applicable)
Unified Business Identifier (UBI No.)
Company Telephone No.
(
)
Company Address (Number, Street and Post Office Box if Applicable)
City
State
Zip
County
Applicant's Mailing Address (Number, Street and Post Office Box if Applicable)
Applicant's Telephone No.
(
)
City
State
Zip
County
Please respond to the following questions:
1. Are you the sole owner of this real estate business?
Yes
No
2. What is zoning of the area in which the office is located?
Is a real estate office permissible in this zone?
Yes
No
3. Is the office in the same building as residence?
Yes
No
4. With the exception of motor vehicle violations, have you ever been convicted of a crime, felony,
or misdemeanor by this state, any other state, the federal government, or any other jurisdiction
within the past ten years? (NOTE: If you have been convicted of a crime, you will be subjected to
Yes
No
an investigation, and you may be denied a license.)
5. Is there a criminal complaint or accusation, or other information presently pending against you, or
are you under indictment in this state, any other state, by the federal government, or by any other
Yes
No
jurisdiction?
6. Has any application for a professional or occupational license or permit made by you ever been
denied, or has a license or permit issued to you ever been suspended, revoked, censured, or fined,
in this state or any other jurisdiction?
Yes
No
7. Have you ever had a civil court order, verdict, or judgment entered against you in any court of
competent jurisdiction in which the subject matter involved any real estate or business related
activity?
Yes
No
8. Are you currently required to register as a sex offender in this state or any other state?
Yes
No
If yes, state_______ county_______
Attach a letter of explanation for any Yes answer(s) to questions 4-8.
*
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.
I declare under penalty of perjury that my answers and all information provided by me herein are true and correct.
X
Signature
Date
For office use only
I
27008
9
1
Prog 1
Tran 3
Prof 4
Pic No. 5
Exp. Date 9
Stat. 11
Birthdate 13
Class 14
Bill 16
Split 43
7
Tax
27
Cert. Date
30
LA Date
40
The Department of Licensing has a policy of providing equal access to its services. If
you need special accommodation, please call (360)664-6500 or TTY (360)664-8885.
RE-620-008 (R/7/06)W Page 1 of 2
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