Form Il 505-0335 - Application For A Real Estate Branch Office/form 505-0341 - Consent To Examine And Audit Special Accounts - 2013

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APPLICATION FOR A REAL ESTATE BRANCH OFFICE
477
ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
Division of Professional Regulation/Real Estate Professions Section
320 West Washington Street
Springfield, Illinois 62786
Real Estate Licensing (855) 445-7763
Important Notice: Completion of this form is necessary to accomplish the requirements outlined in the Illinois Real Estate License Act 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.
INSTRUCTIONS FOR FILING
Type of Firm:
Corporation
Partnership
Independent Broker
Limited Partnership
Limited Liability Company
1.
Type or print legibly. Forward a fee of $125 in the form of a check or money order made payable to the
Illinois Department of Financial and Professional Regulation. FEE IS NOT REFUNDABLE.
2.
The Consent to Examine and Audit Special Accounts form must be properly completed in the principal
office name.
3.
The name of the branch office shall be the same as that of the principal office.
4.
The managing broker of the branch office must associate/transfer himself/herself and all licensees
employed by the branch office only AFTER receipt of the branch office license. A properly completed
sponsor card and the applicable fee must be submitted for each transaction.
1. Name of Principal Office
2. License Number of Principal Office
3. Address of Principal Office (Street, City, County, State and Zip Code)
4. Name of Managing Broker of Branch Office
5. License Number of Managing Broker
6. Address of Branch Office (Street, City, County, State and Zip Code)
7. Branch Office Telephone Number
8. Principal Office Telephone Number
( _ _ _ )
_ _ _ - _ _ _ _
( _ _ _ ) _ _ _ - _ _ _ _
I hereby certify that I personally completed this application, that the answers are true and correct to the best of my knowledge
and belief, and that I am legally authorized to sign for this firm.
_________________________________________________
_______________________
Signature of Branch Managing Broker
Date
IL 505-0335 (Rev 3/13)

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