Fillable ADRE - Form LI-213 Entity Employing Broker Name Reservation Req

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ADRE - Form LI-213 Entity Employing Broker Name Reservation Req

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ADRE Lic Form LI-213 Name Res Req rev 09.24.2012
Page 1 of 1
ARIZONA DEPARTMENT OF REAL ESTATE (ADR
E)
Licensing Division
www.azre.gov
100 North 15th Avenue, Suite 201, Phoenix, Arizona 85007
'28*/$6$'8&(<
GOVERNOR
J
UDY LOWE
COMMISSIONER
ENTITY / EMPLOYING BROKER NAME RESERVATION REQUEST (FORM LI-213)
DESIGNATED BROKER (DB) INFORMATION
Name
License Number
Expiration Date
Email:
Phone:
Fax:
NAME REQUEST – check all that apply
New Legal Name Change Legal Name New DBA Name Change DBA Name
TYPE OF ENTITY – select only one
Corporation (CO) Limited Liability Company (LLC) Partnership (PA)
Sole Proprietor (SE) – DBA only Foreign Entity Qualified in AZ Limited Liability Partnership (PA)
LEGAL NAME REQUEST – must register with the ACC/SOS after ADRE name reservation is approved – not for SE
1
ST
Choice
2
nd
Choice (Considered only if 1
st
Choice is denied)
If using initials, state what initials stand for
DBA NAME – cannot be registered with the ACC/SOS, and must be used in lieu of ADRE approved Legal Name
1
ST
Choice
2
nd
Choice (Considered only if 1
st
Choice is denied)
If using initials, state what initials stand for
FOR ADRE USE ONLY
Expiration Date
Date Stamp
Input Date
Approved
Denied
Processed By
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ADRE - Form LI-213 Entity Employing Broker Name Reservation Req

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Completed 7 May 2020

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