Application For Registration As A Professional Corporation - Nebraska Real Estate Commission - 2015
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2NEBRASKA REAL ESTATE COMMISSION
Phone: 402-471-2004
PO Box 94667
Fax: 402-471-4492
Lincoln, NE 68509-4667
Website:
E-mail:
realestate.commission@nebraska.gov
APPLICATION FOR REGISTRATION AS A PROFESSIONAL CORPORATION
(Registration must be issued annually)
$25.00 Registration Fee
FEES ARE NOT REFUNDABLE
Check here if this is the first filing for a new professional corporation
Name of Corporation_____________________________________________________________________________________
(must be the exact name as reserved or filed with the Secretary of State)
Principal Place of Business:_________________________________________________________________________________
Street Address
City
State
Zip
Practice of:______________________________________________________________________________________________
(Please name profession in which corporation is engaged)
:(
)__________________________________
Telephone Number
OFFICERS OF CORPORATION
This section must be completed. All officers of the corporation except secretary and assistant secretary must be licensed in
Nebraska to render the professional service for which the professional corporation is organized.
________________________________________
____________________________________
President
(Full Name & License #)
Residence - Street Address, City, State, Zip
_______________________________________________
___________________________________________
Vice-President (Full Name & License #)
Residence - Street Address, City, State, Zip
_______________________________________________
___________________________________________
Secretary
(Full Name & License #)
Residence - Street Address, City, State, Zip
_______________________________________________
___________________________________________
Asst. Secretary (Full Name & License #)
Residence - Street Address, City, State, Zip
_______________________________________________
__________________________________________
Treasurer
(Full Name & License #)
Residence - Street Address, City, State, Zip
DIRECTORS
This section must be completed. All directors must be licensed in Nebraska to practice in the profession for which the
corporation was organized. (Use additional sheets if needed)
__________________________________
_________________________________
Full Name & License # (if applicable)
Residence - Street Address, City, State, Zip
______________________________________________
______________________________________________
Full Name & License # (if applicable)
Residence - Street Address, City, State, Zip
______________________________________________
______________________________________________
Full Name & License # (if applicable)
Residence - Street Address, City, State, Zip
______________________________________________
______________________________________________
Full Name & License # (if applicable)
Residence - Street Address, City, State, Zip
Revised 6/15
(please complete reverse side)
Neb. Rev. Stat. 21-2216
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