Form 45664 - Application For Real Estate Appraiser Permit For Temporary Practice

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APPLICATION FOR REAL ESTATE APPRAISER
REAL ESTATE APPRAISER LICENSURE & CERTIFICATION BOARD
PERMIT FOR TEMPORARY PRACTICE
PROFESSIONAL LICENSING AGENCY
402 West Washington Street, Room W072
State Form 45664 (R6 / 10-06)
Indianapolis, IN 46204
Telephone: (317) 234-3009
Approved by State Board of Accounts, 2006
E-mail: pla9@pla.IN.gov
INSTRUCTIONS:
Please type or print all information.
* Your Social Security number is being requested by this state agency in accordance with IC 4-1-8-1. Disclosure is mandatory, and this record cannot be processed without it.
FOR OFFICE USE ONLY
Application fee
Date fee paid (month, day, year)
Receipt number
Permit number
Date permit issued (month, day, year)
DO NOT WRITE ABOVE THIS LINE
Permit for temporary practice as a:
Licensed residential appraiser
Certified residential appraiser
Certified general appraiser
TEMPORARY PERMIT HISTORY
Have you ever applied to the Indiana Real Estate Appraiser Licensure and Certification Board for a permit for temporary practice?
Yes
No
If yes, how many previous temporary permits have you been granted?
Please provide issuance dates for previous permits (month, day, year)
APPLICANT INFORMATION
Name of applicant (last, first, middle, maiden or previous)
Social Security number *
Date of birth (month, day, year)
Place of birth (city, state)
Name of appraisal business
Appraisal business mailing address (number and street, city, state and ZIP code)
Business telephone number
Residential telephone number
E-mail address
(
)
(
)
APPRAISAL ASSIGNMENT INFORMATION
Assignment address (number and street, city, state, and ZIP code)
Date project will begin (month, day, year)
How long will your assignment take? (indicate days, weeks, or months)
CURRENT EMPLOYER
Name of company
Address (number and street, city, state, and ZIP code)
STATE LICENSURE / CERTIFICATION VERIFICATION
Pursuant to 876 IAC 3-3-21, the Board will recognize, on a temporary basis, the license or certificate of an appraiser issued by another state, providing
the following: (1) the appraiser’s business is of a temporary nature; (2) the appraiser registers with the Board; and (3) the license or certificate issued
by the other state is appropriate for the type of property to be appraised in Indiana.
Type of license / certification held
License / certification number
State of issuance
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