Fill - Free fillable *** ALL TRANSACTIONS MUST BE PAID BY MONEY (Nevada Real Estate Division) PDF form

STATE OF NEVADA

DEPARTMENT OF BUSINESS AND INDUSTRY

REAL ESTATE DIVISION

3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 * (702) 486-4033

e-mail: realest@red.nv.gov * http://red.nv.gov/

Revised: 12/11/2018 Page 1 of 5 553

APPLICATION FOR APPRAISER REINSTATEMENT

$30 ⎯ Reinstatement fee for license

*** ALL TRANSACTIONS MUST BE PAID BY MONEY ORDER, CHECK OR EXACT CHANGE ***

License Number:

Name of Licensee:

Last

First

Middle

Business Phone

Home Address:

No. & Street

City

State

Zip Code

Corporation and/or Business Name:

Business Address:

No. & Street

City

State

Zip Code

Mailing Address:

No. & Street

City

State

Zip Code

Have you been involved in any litigation, administrative, civil or criminal, as defendant, over real estate transactions or matters

pertinent thereto, since original issuance of license? Yes No

Has anyone filed suit or obtained judgment against you in any matter whatsoever since original issuance of license?

Yes No

Have you ever had a license, certificate or registration issued to you by any public authority suspended or revoked?

Yes No

Have you ever had an application for a real estate appraiser license, certificate or registration denied?

Yes No

Are you currently under an administrative investigation in any other state or jurisdiction? Yes No

Has any proceeding ever been instituted by or against you under the Bankruptcy Act, or have you ever made an assignment for

the benefit of creditors? Yes No

Have you ever been convicted of a felony; gross misdemeanor; or misdemeanor? Yes No

Are you presently on parole or probation? Yes No

Have you ever entered a plea of “nolo contendere” to a criminal action? Yes No

If your answer to ANY of the above is “Yes,” give full details, including the court, case number, title of the proceeding,

disposition and any other pertinent information on an attached sheet.

hereby apply to

APPRAISERS:

Reinstate my license/registration card to active status.

Attach proof of continuing education

Applicant’s Signature

NONRESIDENTS:

Complete

Date

Consent to Service of Process Form

Revised: 12/11/2018 Page 2 of 3 553

IMPORTANT

PURSUANT TO NRS 645C.295, THE FOLLOWING STATEMENT MUST BE ANSWERED AND

SIGNED. YOUR APPLICATION FOR THE ISSUANCE OF THIS LICENSE WILL BE DENIED IF

YOU DO NOT INDICATE ON THE STATEMENT WHICH OF THE PROVISIONS APPLIES TO

YOU.

I am NOT subject to a court order for the support of a child.

I am subject to a court order for the support of one or more children and AM IN COMPLIANCE with that

order or plan approved by the district attorney or other public agency enforcing the order for the

repayment of the amount owed in that order.

I am subject to a court order for the support of one or more children and NOT IN COMPLIANCE with

that order or plan approved by the district attorney or other public agency enforcing the order for the

repayment of the amount owed in that order.

I hereby certify under penalty of perjury that the answers contained in this application are true and correct.

I understand that if I am subject to a court order for support of one or more children and I am not in compliance with that

order or plan, my application for license, certification or renewal of a license or certification will be denied.

I further certify that I will faithfully comply with all the statutes and regulations of the State of Nevada pertaining to the

conduct of real estate appraisers in the State of Nevada.

Applicant Name (Print)

Signature

CONSENT TO SERVICE OF PROCESS

FOR NON-RESIDENT USE ONLY

Last

First

M.I.

Hereinafter referred to as

“Applicant,” hereby irrevocably constitutes and appoints the Administrator of the Division of Real Estate, Department of

Business & Industry, State of Nevada or his/her successor in office, to be his/her true and lawful attorney within this

state, upon whom all legal process in any suit, action or proceeding arising under, or in any way connected with any

provisions of Chapter 645, 645C, 119, 119A, 119B of Nevada Revised Statutes, or any rule or order pursuant thereto, or

based upon any fraud, deceit, breach or contract or other thing connected with the sale or offer for sale, negotiation or

appraisal of any real estate, timeshare or campground membership, may be served upon said applicant, personally within

the State of Nevada. Until the applicant attests by affidavit to the Administrator that he/she is a bona fide resident of the

State of Nevada, this appointment and the authority of said attorney shall continue in force and effect so long as any such

liability remains outstanding, and a copy of any process served hereunder may be sent by certified mail, return receipt

requested, addressed to:

Street Address City State Zip Code

Drivers License Number

State

STATE OF

Ss. County of

I certify that this is a true and correct copy of a document in the possession of

(Name of person who presents the document)

Date

Signature of Notarial Officer

(Seal)

My Commission Expires:

Revised: 12/11/2018 Page 3 of 3 553

REPORT OF EXISTENCE OF NEVADA BUSINESS LICENSE

Pursuant to NRS 645C

All applicants MUST complete this section. Please select ONE option.

I have a Nevada business license number assigned by the Nevada Secretary of State upon compliance

with the provisions of NRS Chapter 76.

My Nevada business license number is: _______________________________________

I have applied for a Nevada business license with the Nevada Secretary of State upon compliance with

the provision of NRS Chapter 76 and my application is pending.

I do NOT have a Nevada business license number.

The Real Estate Division is not the arbiter of determining whether the applicant needs a business license.

Information about the Nevada business license can be found on the Secretary of State’s website at:

http://nvsos.gov/

ARE YOU A VETERAN?

Yes

0505RCCD-003(07/2017rev)

Fingerprint Background Waiver Page 1 of 2

Fingerprint Background Waiver

As an applicant who is the subject of a Federal Bureau of Investigation (FBI) fingerprint-based

criminal history record check for a noncriminal justice purpose you have certain rights which are

discussed below.

1. You must be notified by the Nevada Real Estate Division (name of requesting agency)

that your fingerprints will be used to check the criminal history records of the FBI and the

State of Nevada.

2. If you have a criminal history record, the officials making a determination of your suitability

for the job, license or other benefit for which you are applying must provide you the

opportunity to complete or challenge the accuracy of the information in the record. You may

review and challenge the accuracy of any and all criminal history records which are returned

to the submitting agency. The proper forms and procedures will be furnished to you by the

Nevada Department of Public Safety, Records Bureau upon request. If you decide to challenge

the accuracy or completeness of you FBI criminal history record, Title 28 of the Code of

Federal Regulations Section 16.34 provides for the proper procedure to do so:

16.34 - Procedure to obtain change, correction or updating of identification

records. If, after reviewing his/her identification record, the subject thereof

believes that it is incorrect or incomplete in any respect and wishes changes,

corrections or updating of the alleged deficiency, he/she should make application

directly to the agency which contributed the questioned information. The subject of

a record may also direct his/her challenge as to the accuracy or completeness of any

entry on his/her record to the FBI, Criminal Justice Information Services (CJIS)

Division ATTN: SCU, Mod. D-2, 1000 Custer Hollow Road, Clarksburg, WV 26306.

The FBI will then forward the challenge to the agency which submitted the data

requesting that agency to verify or correct the challenged entry. Upon the receipt of

an official communication directly from the agency which contributed the original

information, the FBI CJIS Division will make any changes necessary in accordance

with the information supplied by that agency.

3. Based on 28 CFR § 50.12 (b), officials making such determinations should not deny the

license or employment based on information in the record until the applicant has been

afforded a reasonable time to correct or complete the record or has declined to do so.

4. You have the right to expect that officials receiving the results of the fingerprint-based

criminal history record check will use it only for authorized purposes and will not retain or

disseminate it in violation of federal or state statute, regulation or executive order, or rule,

procedure or standard established by the National Crime Prevention and Privacy Compact

Council.

0505RCCD-003(07/2017rev)

Fingerprint Background Waiver Page 2 of 2

5. I hereby authorize the Nevada Real Estate Division (name of requesting agency)

(name of requesting agency), to submit a set of my fingerprints to the Nevada Department

Public Safety, Records Bureau for the purpose of accessing and reviewing State of Nevada

and FBI criminal history records that may pertain to me.

In giving this authorization, I expressly understand that the records may include information

pertaining to notations of arrest, detainments, indictments, information or other charges for

which the final court disposition is pending or is unknown to the above referenced agency.

For records containing final court disposition information, I understand that the release may

include information pertaining to dismissals, acquittals, convictions, sentences, correctional

supervision information and information concerning the status of my parole or probation

when applicable.

6. I hereby release from liability and promise to hold harmless under any and all causes of legal

action, the State of Nevada, its officer(s), agent(s) and/or employee(s) who conducted my

criminal history records search and provided information to the submitting agency for any

statement(s), omission(s), or infringement(s) upon my current legal rights. I further release

and promise to hold harmless and covenant not to sue any persons, firms, institutions or

agencies providing such information to the State of Nevada on the basis of their disclosures. I

have signed this release voluntarily and of my own free will.

A reproduction of this authorization for release of information by photocopy, facsimile or similar

process, shall for all purposes be as valid as the original.

In consideration for processing my application I, the undersigned, whose name and signature

voluntarily appears below; do hereby and irrevocably agree to the above.

Applicant’s Name:

PLEASE PRINT

Last Name

First Name

Middle

ADDRESS:

PLEASE PRINT

Applicant’s Signature:

Date:

Submitting Agency:

Nevada Real Estate Division

Address:

3300 West Sahara Avenue #350

Las Vegas, NV 89102

Agency Representative:

PLEASE PRINT

Last Name

First Name

Middle

Agency Representative Signature:

Date:

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