Broker Verification Form - Utah Division Of Real Estate

ADVERTISEMENT

State of Utah
B
V
F
ROKER
ERIFICATION
ORM
Department of Commerce
Division of Real Estate
Please provide this form to each Broker with whom the applicant has affiliated during the five years proceeding application and have
each Broker complete (type or neatly print), sign (notarized) and seal this form in an envelope with the Broker’s signature across the
seal and submit to the Utah Division of Real Estate at the address below.
Applicant: __________________________________________________
License No. ____________________________________
Physical Address: _____________________________________________________________________________________________
Mailing Address: _____________________________________________________________________________________________
Phone:
___________________________________________
Fax: _________________________________________________
Broker:
__________________________________________________
License No. ____________________________________
Company Name _____________________________________________________________________________________________
Address: ___________________________________________________________________________________________________
Phone:
___________________________________________
Fax: _________________________________________________
I, _________________________________________, the undersigned to verify that _______________________________________,
who is an applicant for a broker license has been licensed as an agent with me for the period of ______________________________
to ______________________________.
During that time the applicant worked an average of __________ hours per week.
While affiliated with this brokerage the applicant closed __________ transactions, representing a dollar volume of $__________.
While affiliated with this brokerage the applicant devoted the following percentage of time in the following categories:
Residential __________
Commercial __________
Property Management __________
Other __________
I
( ) would
( ) would not
recommend the applicant as a Principal Broker for the State of Utah.
Comments: __________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
I hereby certify that the information provided is true and correct.
Signature ________________________________________________________
Date ______________________________
State of _________________________
County of _________________________
Appeared before me this __________ day of
______________________, ___________, _______________________________________________, who deposes and says that the
information listed above is true to the best of his/her knowledge. (Notary)________________________________________________
Rev.12/12/06
160 East 300 South, PO Box 146711, Salt Lake City, UT 84114-6711
Telephone (801) 530-6747 • Facsimile (801) 526-4387 • Internet:

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go