Form 623 - Registration Filing Addendum

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STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY - REAL ESTATE DIVISION
COMMON-INTEREST COMMUNITIES AND CONDOMINIUM HOTELS PROGRAM
2501 East Sahara Avenue, Suite 201 * Las Vegas, NV 89104-4137
(702) 486-4480 * Toll free: (877) 829-9907 * Fax: (702) 486-4520
E-mail:
CICOmbudsman@red.nv.gov
REGISTRATION FILING ADDENDUM
Association’s Legal Name ___________________________________________________________________________
(The name of the association as it appears in the Articles of Incorporation)
Association’s Subdivision Name(s) ___________________________________________________________________
(For instructions on how to locate the subdivision name, visit )
Nevada Secretary of State (SOS) Entity Number _______________________ SOS Original File Date ___/___/___
(For SOS Filing information, visit )
Is the Association identified as a Master or Sub-association, per the CC&Rs?
Master
Sub-Association
Neither
If identified as a Sub-Association, please indicate the name of the Master Association ______________________________________
This form is submitted to the Division as notification of (check all applicable)
Change of Licensed Community Manager and Management Company
Change of Licensed Community Manager within Current Management Company
Change of Attorney of Record
Change(s) of Board of Directors (See page 2)
(Top portion of page 1 required to be completed, if no other changes)
Change of Mailing Address
Current Notification Address for Division Use
Mailing Address of Management Company
(If professionally managed, include name of the Management Company)
Same as Notification Address
C/O ________________________________________________
Company Name ______________________________________
____________________________________________________
Address ___________________________________________________
City _______________________ State ______ Zip __________
City _______________________ State ______ Zip __________
Association’s Telephone Number ________________________
Fax Number _________________________________________
(This phone number will be supplied to the public)
Management/Custodian of Records
Name of the Community Manager assigned to association……………………… ___________________________________________
(Provide name as it appears on the license issued by the Real Estate Division)
License number ……………………………… CAM #
TEMP
PROV *
CM
SUPR
* List the Supervising Community Manager ______________________________________ CAM # _____________.SUPR
(Provide name as it appears on the license issued by the Real Estate Division)
Provide the date the above listed management company began management …………………………………… _____/______/______
If this is notification of a new Licensed Community Manager, date began management ……………………….. _____/______/______
Name of the individual designated as the Custodian of Record ……. ____________________________________________________
List the address where the association’s records are located
Company Name
Phone Number __________________ Fax Number _______________
(if applicable)
Address
City
State ______ Zip _____________
FOR OFFICIAL USE ONLY
DOCS Qty.
Processed By
Date Processed
First Date Stamp
Data Entry Notes
Second Date Stamp
Revised 8/13/15
Page 1 of 3
Form 623

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