Form Re-620-135 - Real Estate Corporation License Application

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Real Estate Corporation

License Application

Make remittance payable to Washington State Treasurer.

Send this application with your remittance to:

Department of Licensing

PO Box 9048

Click here to START or CLEAR, then hit the TAB button

for validation only

Olympia, Wa 98507-9048

for additional information call (360) 664-6488 or (360) 664-6500

Fee: $210.00

If application is incomplete, it will not be processed.

Name of corporation

Unified Business Identifier (UBI no.)

DBa name (If applicable)

Designated broker's name

Social Security no.*

Business area code & phone no.

Company address (Number, Street and Post office box if applicable)

Designated broker's area code & phone no.

City

State

ZIP code

President

President's mailing address (Street, City, State, ZIP code)

Vice President

Vice President's mailing address (Street, City, State, ZIP code)

Secretary

Secretary's mailing address (Street, City, State, ZIP code)

Treasurer

Treasurer's mailing address (Street, City, State, ZIP code)

for change of address only, former address (Street, City, State, ZIP)

for change of designated broker only, name of outgoing broker

for company name change only, former company name

Office location zone designation

Is a real estate office permitted in this zone?

Yes

Does the corporation agree to establish and maintain a publicly accessible real estate office at the business address?

Yes

*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.

Attach a letter of explanation for any Yes answer(s) to the following questions.

1. With the exception of motor vehicle violations, have you or any officer of the corporation 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

(NOTE: If you or any corporate officer have been convicted of a crime, you will be subjected to an

investigation, and you may be denied a license.)

2. Is there a criminal complaint or accusation, or other information presently pending against

you or any corporate officer, or are you or any corporate officer under indictment in this state,

any other state, by the federal government, or by any other jurisdiction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

3. Has any professional or occupational license or permit issued to you or any corporate officer,

or your right or the right of any corporate officer to engage in any business ever been refused,

suspended, revoked, or denied in this state or any other jurisdiction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

4. Have you or any corporate officer 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

5. are you currently required to register as a sex offender in this state or any other state? . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If yes, state ________________ county _____________________________

The designated broker agrees to personally manage and act for and on behalf of the corporation. Failure to comply with any provision of

the Real Estate Licensing Act or any rule or regulation promulgated thereunder may result in suspension or revocation of license.

I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.

_____________________________________________

________________________________________________________________________

Date and place

Designated broker's signature

The Department of Licensing has a policy of providing equal access to its services.