Sales Person Or Contract Broker Registration Application Page 2
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1
210.
If you answered yes to Question 9, explain fully the circumstances of the refusal.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
11.
Has your license as a real estate broker or salesperson in this or any other state ever been revoked or
suspended?
_______ Yes ________ No
12.
If you answered yes to Question 11, explain fully the circumstances of the denial or suspension.
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
I certify (or declare), under penalty of perjury, that I have read the foregoing registration and that all the answers are
true and correct. Further, I understand and agree that any misstatements of a material fact in this application may
result in suspension or revocation of my registration with the State of Texas.
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____________________________________________
Signature of Applicant
************************************************************
RETURN THIS APPLICATION WITH THE $50.00 FILING FEE TO:
SECRETARY OF STATE
REGISTRATIONS UNIT
P. O. BOX 13550
AUSTIN, TX 78711-3550
FOR DELIVERY:
JAMES EARL RUDDER OFFICE BUILDING
1019 BRAZOS
AUSTIN, TX 78701
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