Form Fint02 - Escrow Officer Renewal Application
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2FINT02 | 0316
ESCROW OFFICER LICENSE RENEWAL
APPLICATION RENEWAL FEE $35.00
Title Agent Information
TITLE AGENCY NAME _________________________________________________
License Type: Escrow Officer
Firm ID: ________________
DBA not required, if any
Expiration Date: __________________
MAILING ADDRESS ___________________________________________________
Invoice ID:
_________________
CITY, STATE ZIP CODE _________________________________________________
Escrow Information
License No: ______________________
Individual ID: _________________
Escrow Officer Name: _______________________
Escrow Officer Renewal Application Form
This form comprises part of the application for the renewal of the license listed above. All required items must be submitted
together in a timely manner. Failure to comply with any one of these requirements may result in non-renewal of your license.
Escrow Officer named above must answer questions 1 through 5 and provide the information requested.
1. Excluding traffic violations and first offense DWI:
a.
Do you currently have any pending misdemeanor or felony charges (by indictment, information or
any other instrument) filed against you in Texas, any other state, or by the federal government?
Yes
No
b. Have you ever been convicted of any misdemeanor or felony offense in Texas, any other state, or
by the federal government?
Yes
No
c.
Have you ever had adjudication deferred on any misdemeanor or felony charge or offense in Texas,
any other state, or by the federal government?
Yes
No
d. Have you ever served any period of probation for any misdemeanor or felony offense in Texas, any
state, or by the federal government?
Yes
No
If you answer “Yes” to question 1a, 1b, 1c, and/or 1d, you must submit original CERTIFIED copies of the indictment or charging
document, conviction, order deferring adjudication, judgment and conditions of probation from the appropriate jurisdiction,
for each and every crime or offense. You may also include letter of recommendation on your behalf. Please provide full
information with dates and details on a separate sheet of paper. Application processing will be suspended until the details are
received and a review is completed. However, if certified documents were previously provided to this Department, do not
resubmit.
2. Have you ever had an application for license denied by the State of Texas or any other state?
Yes
No
If “Yes”, give details on a separate page.
3. Have you ever had a license suspended or revoked by the State of Texas or any other state?
Yes
No
If “Yes”, give details on a separate page.
4. Have you completed Continuing Education requirements?
Yes
No
If “Yes”, give total hours: ________
Explanation of Item 4:
This question concerns completion of Continuing Education requirements per the requirements of Procedural Rule P-28, Sec.
12 (b). If you answer “Yes” to item 4 and give total hours completed, this renewal application constitutes a certified summary of
completion certificate. You must attach individual copies of completion certificates as a part of this renewal application form.
You must retain the individual completion certificates for a period of four (4) years.
Notice: Your total requirements must include 1 hour of ethics if license is 10 months or more.
Continuing Education Hours
License Period
Total Required HOURS
Ethics
Less than 4 months
0
0
4 months up to and including 6 months
4
0
7 months up to and including 9 months
5
0
10 months up to and including 12 months
6
1
13 months up to and including 15 months
7
1
16 months up to and including 18 months
8
1
19 months up to and including 21 months
9
1
22 months or more
10
1
(INCREMENTS ARE IN FULL MONTHS DO NOT COUNT PARTIAL MONTHS)
Texas Department of Insurance |
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