Form 08-4076 - Application To Change License Status - Department Of Commerce And Economic Development - Alaska Page 2
ADVERTISEMENT
1
2TERMINATING BROKER INFORMATION
Business Name
Business Mailing Address
(City)
(State)
(ZIP Code)
Broker Name (Please Print)
Telephone #
Broker's Signature
Date
Return original signed and dated license to Real Estate Commission
--- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- ---
(If employed in branch office, complete this section also.)
Branch Office Name
Telephone #
Mailing Address
Street/P.O. Box
City
State
Zip Code
Associate Broker's Signature
Date
EMPLOYING BROKER INFORMATION
Business Name
Telephone #
Business Mailing Address
Street/P.O. Box
City
State
ZIP Code
Employing Broker's Name
Broker #
Broker Signature
Date
--- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- ---
(If employed in branch office, complete this section also)
Branch Office Name
Telephone #
Mailing Address
Street/P.O. Box
City
State
ZIP Code
Associate Broker's Signature
Date
AFFIDAVIT OF APPLICANT
I hereby certify that the above information is true and correct to the best of my knowledge. I understand that any false or
misleading information may result in denial, suspension, or revocation of the license for which I have applied, or for any
Alaska real estate license that I now hold.
Applicant/Licensee Signature
SUBSCRIBED AND SWORN TO before me this
day of
199
.
Notary Public for the State of Alaska
SEAL
My Commission Expires:
08-4076 (Rev. 6/98)
GO/dgl
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form 08-4251 - Application For Veterinary Technician Licensure - Department Of Community And Economic Development
Legal
Form 08-4004f - Add/change Of Mobile Intensive Care Paramedic Sponsor - Alaska Department Of Commerce And Economic Development
Legal
Form 08-4356 - Application To Upgrade The Tonnage Of A Deputy Marine Pilot License - Department Of Commerce And Economic Development
Legal
Form 08-4172 - Procedure For Obtaining A Permit To Administer Parenteral Sedation - Alaska Department Of Commerce And Economic Development
Legal
Form 08-4144 - Application For Reinstatement Form - Department Of Community And Economic Development Alaska State Board Of Public Accountancy Division Of Occupational Licensing
Business
Form 08-458 - Application For Amended Certificate Of Registration - Department Of Commerce And Economic Development
Legal
Form 08-4076a - Broker Notice To Real Estate Commission Of Licensee Termination Form - Department Of Commerce And Economic Development
Legal
Form 08-4109f - Board Action Data Bank Inquiry Form - Department Of Community And Economic Development - Alaska
Legal
Related Categories
Parent category: Legal