Form Rea-Amc-02 - Biographical Affidavit To Support
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4OKLAHOMA REAL ESTATE
APPRAISER BOARD
5 Corporate Plaza
3625 NW 56th St, Ste 100, Oklahoma City, OK 73112
(405) 521-6636, Fax 522-6909
Email:
Website:
reabadmin@oid.ok.gov
BIOGRAPHICAL AFFIDAVIT
TO SUPPORT FORM REA-AMC-02
SECTION A: APPRAISAL MANAGEMENT COMPANY
1.
NAME OF ENTITY (Exactly as reported on REA-AMC-01 and AMC-02)
2.
FEI NUMBER
In connection with the Application for Registration of the above-named appraisal management company, I herewith make representations and
supply information about me as hereinafter set forth. (Attach addendum or separate sheet if space hereon is insufficient to answer any
question fully.) IF ANSWER IS “NO”, “NONE”, OR NOT APPLICABLE ("NA"), SO STATE.
1.
NAME
2.
SOCIAL SECURITY NUMBER [56 O.S. § 240.21(A)]
Last
First
Middle
Suffix
3.
NAMES PREVIOUSLY USED: Maiden, previously married, previously used, nicknames, etc.
4.
MAILING ADDRESS
Address
City
State
ZIP
5.
BUSINESS TELEPHONE NUMBER
6.
BUSINESS FAX
7.
PHYSICAL RESIDENCE ADDRESS
Address
City
State
ZIP
8.
EMAIL ADDRESS
9.
DATE OF BIRTH
10. a.
Are you a citizen of the United States?
Yes
No
b.
Are you a citizen of any other country?
Yes
No
c.
If so, what country? __________________________________________
11. Occupation or Profession.
12. Present or proposed position with the applicant entity. _________________________________________________________________
13. If an owner of the applicant entity, state the percentage of ownership.
Biographical Affidavit – Supplement to AMC-02 (1301)
Page 1 of 4
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