Form 47914 - Application For Registration For Real Estate Professional Corporation Page 2
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1
2AFFIDAVIT OF SHAREHOLDER
A CORPORATION OF LICENSED REAL ESTATE PROFESSIONALS
STATE OF
}
SS:
COUNTY OF
_____________________________________________________________________ being duly sworn, deposes and says that
he/she is a licensed Real Estate Professional of the State of Indiana, his/her office and principal place of business being located
at _____________________________________________________________________, Indiana. That he/she is a shareholder
of the Corporation known as _________________________________________________________________________, that all
statements made in this application regarding the said Corporation are true; that said Corporation has complied with all provisions
of corporation laws of this state applicable thereto; that each shareholder of said Corporation is a licensed Real Estate Professional
in good standing of the State of Indiana; that each officer is a licensed Real Estate Professional of Indiana in good standing and
each director is a qualified person as defined by IC 25-31-1-18.
Subscribed and sworn to before me this _______ day of ___________________________________, ____________.
Signature of applicant
Signature of Notary Public
Printed or typed name of applicant
Printed or typed name of Notary Public
Date subscribed and sworn to (Notary Public)
County of residence
Date commission expires
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