Form Rec 1.39a - Affidavit Of Notificatino Of Change In Time Share Project Broker, Registrar, Or Independent Escrow Agent - North Carolina Real Estate Commission

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North Carolina Real Estate Commission
P.O. Box 17100, Raleigh, N.C. 27619-7100
Phone (919) 875-3700 • E-mail: RA@ncrec.gov
Website:
AFFIDAVIT OF
NOTIFICATION
OF CHANGE IN
TIME
SHARE
PROJECT
BROKER, REGISTRAR, OR INDEPENDENT ESCROW AGENT
Instructions
1.
This form must be properly
executed
by the Developer and accompanaied by the appropriate Affidavit
of Project
Broker,
Registrar,
or
Independent Escrow
Agent.
2.
Use
only one
form for
each position
being
appointed (i.e.,
if
a Developer proposes
to
designate
a new
Project
Broker
and
a
new
Registrar,
complete
and file
two forms--one
for
each
position).
Project
Name:_______________________________
Time Share Registration
No.:____________
Project
Address:_____________________________________________
Telephone
No.: ___________________
The
undersigned
Developer,
being
duly
sworn
deposes
and
says:
That
he or she has read
and
understands
the
provisions
of
N.C.G.S.
93A-41, 42, and 58,
making
it unlawful
to
sell or offer
to sell
time
shares in
this State without a PROJECT
BROKER,
a
REGISTRAR,
and (in
certain
circumstances) an
INDEPENDENT
ESCROW
AGENT,
and
that
in
compliance
therewith,
the
Developer hereby designates ________________________________________________ as
the above referenced Time Share Project’ s _______________________________ to fulfill the duties required
of such position
commencing on
______________, 20____.
FURTHER AFFIANT SAYS
NOT.
If the Developer is a Sole Proprietor or Partnership, this application must be signed by the Sole Proprietor or
General Partner or the Developer’s Attorney.
If the Developer is a Corporation or LLC, this application must be signed by two Executive Officers of the
Corporation, two Managers of the LLC or the Developer’s Attorney.
___________________________________________ _____________________________________________
Name
(please print
or
type)
Title
Name
(please
print
or
type)
Title
___________________________________________ _____________________________________________
Signature
Signature
Subscribed and Sworn
to
be
fore
me
this _______day
of______, 20___.
Subscribed and Sworn
to
be
fore
me
this _______day
of______, 20___.
Notary
Public
in
the State of_____________________________
Notary
Public
in
the State of_____________________________
County of___________________________________________
County of___________________________________________
My Commission Expires_________________________________
My Commission Expires_________________________________
____________________________________________________
____________________________________________________
Signature of Notary Public
Signature of Notary Public
(SEAL)
(SEAL)
REC 1.39A
3/15

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