Form 504 - Real Estate License Or Permit Change Form Page 2
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4_________________________________________________
______________________
license #:
STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
2501 East Sahara Avenue, Suite 102 Las Vegas, NV 89104-4137 (702) 486-4033
E-mail: realest@red.nv.gov
REAL ESTATE LICENSE or PERMIT CHANGE FORM
For Broker Salesperson, Salesperson, Property Manager, and Business Broker
Real Estate License #:
Property Manager Permit #: ______________ Business Broker Permit #: ______________
Name on license: (Please print)
First
Middle
Last
Home address:
Mailing address:
Email address:
_______________________________________
Phone:
___________________________________
CHANGE OF BROKER/EMPLOYER/COMPANY
1. $20
Submit a $20.00 fee per permit if applicable.
Broker license:
Print Broker’s name:
Company name:
Business Phone:
Company address:
2. $20
PERSONAL NAME CHANGE
Submit a copy of a court document (i.e. divorce decree or marriage certificate/court name change).
Submit your original license or original permit.
New Name:
First
Middle
Last
STATUS CHANGE
3. $20
BROKER to BROKER SALESPERSON
4. $20
PROFESSIONAL CORPORATION OR LLC STATUS
Submit your original license.
ADD
REMOVE
INSTRUCTIONS: Your registered company name with the Nevada Secretary of State must be your legal individual name indicated on your Nevada
Real Estate license. You may choose to file Chapter 86 or 89.
Limited Liability Company
Professional Corporation
Submit a copy of the filed:
Submit a copy of the filed:
1. Articles of organization.
1. Articles of incorporation.
2. List of managers/members.
2. List of corporate officers.
Revised 02/01/2015
2 of 4
Form 504
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