State Form 932 - Application For Real Estate License As A Corporation

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FOR OFFICE USE ONLY
APPLICATION FOR REAL ESTATE LICENSE AS A CORPORATION
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State Form 932 (R6/4-94)
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Approved by State Board of Accounts 1991
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Pursuant to IC 25-1-8-2(e), all fees are nonrefundable and nontransferable.
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INSTRUCTIONS: 1. Fo r b ranc h o ffice re gis tration , ple ase requ es t Bra nc h O ffice Regis tratio n Form (s)
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2. Attach copy of Certificate of Incorporation from the Secretary of State.
3. If company has been incorporated for more than a year, also enclose a copy of Certificate of Existence.
4. If remittance is by personal check, the license will be held for two (2) weeks.
5. Mail fifty dollar ($50.00) License Fee to:
Indiana Real Estate Commission
* Your Federal identification number is requested in accordance with IC
Indiana Professional Licensing Agency
4-1-8.1. However disclosure is not mandatory. The number will be given
to the Indiana Department of Revenue.
302 W. Washington St., Rm. E034
Indianapolis, IN 46204
CORPORATION INFORMATION
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Name of corporation
Federal identification number
County
Address (number and street, city, state, ZIP code)
RESIDENTIAL ADDRESS
LICENSE NUMBER
OFFICER'S NAME
TITLE
LICENSE NUMBER
NAME OF PRINCIPAL BROKER
RESIDENTIAL ADDRESS
NAME OF SALESPERSONS AND BROKERS
(CHECK ONLY ONE)
RESIDENTIAL ADDRESS
LICENSE NUMBER
Salesperson
Broker
Salesperson
Broker
Salesperson
Broker
Salesperson
Broker
Salesperson
Broker
Signature of Secretary, President, or Vice President
Date
Telephone number
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