Form Il 505-0514 - Application For A Real Estate Limited Liability Company License, Form 505-0341 - Consent To Examine And Audit Special Accounts Page 2
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1
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3LIMITED LIABILITY COMPANY APPLICATION
481
Illinois Department of Financial and Professional Regulation
Division of Professional Regulation / Real Estate Professions Section
320 West Washington Street
Springfield, IL 62786
Real Estate Licensing 800/560-6420
Important Notice: Completion of this form is necessary to accomplish the requirements outlined in the Illinois Real Estate Act of 2000 {225
ILCS 454}. Disclosure of this information is REQUIRED. Failure to comply may result in this form not being processed. This form has been
approved by the Agency Forms Coordinator
.
Company Name
Assumed Name (DBA) - if applicable
Date of Organization
Address (Street, City, State, Zip Code)
Telephone Number
FEIN Number
(_ _ _ ) _ _ _ - _ _ _ _
Name of Managing Broker
Managing Broker License Number
Firm License Number (If
Applicable)
Name of Principal Filing Application
Business Address of the Registering Principal (Street, City,
State, Zip Code)
List All Members including individuals, Corporation(s), Partnership(s) or other entity that is a member.
(If
additional space is required please attach a separate listing.
Name/Entity
Illinois Real Estate
Percent of
Illinois Business Address (Street, City,
License Number
Ownership
State, Zip Code )
I hereby certify that I personally completed this form, that the information is true and correct, and that I am legally
authorized to sign for this firm. I further certify that each Member not licensed in the State of Illinois is not
actively participating in the brokerage business as defined in the Illinois Real Estate License Act of 2000, Sec.
5(15). I understand that any change in Members or ownership interest shall require the LLC to file an application
reflecting those changes.
Signature of Managing Broker
Date
______________________________________________________
________________
IL 505-0514 (Rev 3/13)
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