Form 47914 - Application For Registration For Real Estate Professional Corporation

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APPLICATION FOR REGISTRATION FOR

FOR OFFICE USE ONLY

REAL ESTATE PROFESSIONAL CORPORATION

Control number

State Form 47914 (R / 7-99)

Approved by State Board of Accounts, 1996

Date (month, day, year)

Indiana Real Estate Commission

FEE: $25.00

Federal I.D. number

INSTRUCTIONS:

Mail check or money order payable to: Indiana Professional Licensing Agency

Your Federal I.D. number is requested

302 W. Washington St., Rm. E034

pursuant to IC 4-1-8-1. Disclosure is

not mandatory. The number will be

Indianapolis, IN 46204

given to the Indiana Department of

Revenue.

Professional Real Estate corporations may be organized, upon compliance with the Professional Corporations Act of 1983, IC 23-1.5 and IC 23-1.5-2-3(6)

of the Indiana License Law Rules and Regulations.

Notification shall be given to the Secretary of State's office and the Indiana Real Estate Commission thirty (30) days after a change of business address of

the Corporation, and the admission or withdrawal of shareholder, giving the names and addresses of both the transferer and transferee shareholders. Also a

certified copy of all amendments to the Articles of Incorporation must be submitted to the Secretary of State's office and the Indiana Real Estate Commission.

One shareholder shall execute affidavbit of shareholder on the back of this application.

Gentlemen:

The proposed Corporation known as _________________________________________________________________________

is engaged in the practice of Real Estate in this state and hereby makes application for registration pursuant to the Professional

Corporation Act of 1983, IC 23-1.5.

The principle office of the Corporation within the State of Indiana is:

Name

Address (street, city, state, ZIP code)

Telephone number

(

)

SHAREHOLDERS, DIRECTORS AND OFFICERS