Reciprocal License Application
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1
2REAB/REC Rev. 05/2013
Real Estate Appraiser
RECIPROCAL LICENSE APPLICATION
Make fees payable to the Louisiana Real Estate Appraisers Board. Money orders, personal or company checks, and
certified or cashier’s checks are accepted. Please do not send cash through the mail.
Remit: Initial License Fee…………………………$200.00
Processing Fee…………………………… $ 25.00
Research & Education Fund Fee… $ 20.00
Federal Registry Fee…………………… $ 80.00
TOTAL AMOUNT DUE………………… $325.00
Submission of this application shall certify that the applicant is currently licensed as a real estate appraiser in
compliance with Title XI of the Financial Institutions Reform, Recovery, and Enforcement Act of 1989 (FIRREA).
□
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Resident jurisdiction in which the applicant is licensed: ___________________
Residential or
General
GENERAL INFORMATION
1. Last name: _________________________
First name: _________________________
Middle initial: _____
2. SSN: ___ ___ ___ - ___ ___ - ___ ___ ___ ___
3. DOB: (mm/dd/yyyy) ________________________________
BUSINESS INFORMATION
4. Business address: ____________________________________________________________________________
City, state, zip:
____________________________________________________________________________
5. Business phone: (
) _________________________
Fax number: (
) _________________________
LICENSE HISTORY
6. List all states where you are currently, or have been previously, certified or licensed as a real estate appraiser.
STATE
CLASSIFICATION
NUMBER
ISSUE DATE
EXPIRATION DATE
BACKGROUND INFORMATION
7. Have you ever been convicted of, or pleaded guilty or nolo contendere to, forgery, extortion, conspiracy to
defraud, theft, or a crime involving moral turpitude, or a felony crime in any court of competent jurisdiction?
□
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Yes
No
Attach a detailed letter of explanation for any “yes” answer.
REAB • Post Office Box 14785 • Baton Rouge, LA • 70898-4785 • (225) 925-1923 or (800) 821-4529 (LA only)
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