Fillable Application for Registration as an Appraisal Management Company (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Application for Registration as an Appraisal Management Company (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Real Estate Appraiser Board
124 Halsey Street, 3rd Floor, P.O. Box 45032
Newark, New Jersey 07101
(973) 504-6480
Application for Registration as an
Appraisal Management Company
Instructions
Each person that: provides appraisal management services, as dened at N.J.A.C. 13:40A-9.2, to creditors or to secondary mortgage
market participants and afliates; provides such services in connection with valuing a consumer’s principal dwelling as security for a
consumer credit transaction or incorporating such transactions into securitizations; and within a 12-month calendar year, oversees an
appraiser panel of more than 15 New Jersey certied or New Jersey licensed appraisers in New Jersey or 25 or more state-certied
or state-licensed appraisers in two or more states, shall submit the following application to be registered as an appraisal management
company, unless excluded by N.J.A.C. 13:40A-9.1(c) or N.J.A.C. 13:40-9.4(a)(1).
1. Please print clearly.
2. Each question must be lled out in its entirety. Questions not applicable should be so indicated by entering “N/A.”
3. If additional space is required for any of the questions, attach additional pages using the same format as the space provided.
4. Your application must be signed and notarized.
5. In accordance with N.J.A.C. 13:40A-9.4(b), the certication page must be completed by the compliance ofcer of the appraisal
management company.
6. Submit:
a. Surety bond in the amount of $25,000, consistent with the requirements of N.J.A.C. 13:40A-9.4(c).
b. A nonrefundable application fee of $250.00 in the form of a check or money order made payable to the State of New Jersey.
c. Initial registration fee in the form of a check or money order made payable to the State of New Jersey:
• If applying July 2019 through August 31, 2021 ...............................$2,500.00
• If applying September 1, 2020 through August 31, 2021 .................$1,250.00
7. Each controlling person of an appraisal management company for registration shall submit the Certication and Authorization
Form for Criminal History Background Check and the controlling person’s ngerprints as processed by the vendor under contract
with the state.
8. Forward your complete application and registration fees to:
Division of Consumer Affairs
State Real Estate Appraiser Board
P.O. Box 45032
Newark, NJ 07101
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Real Estate Appraiser Board
124 Halsey Street, 3rd Floor, P.O. Box 45032
Newark, New Jersey 07101
(973) 504-6480
Application for Registration as an
Appraisal Management Company
Application date: _______________________
Month Day Year
A. Appraisal Management Company
1. Name of business: ________________________________________________________________________________________
2. Names, if any, under which it does business in any state:
______________________________________________ _________________________________________________
3. Operating as:
Individual Corporation
Limited Liability Company (L.L.C.) Franchise
Partnership Other (Explain)
4. Federal Tax Identication number: ________________________________________
5. Business contact information:
___________________________________________________________________________________________________
Street address City State ZIP code County
___________________________________________________________________________________________________
P.O. Box City State ZIP code County
___________________________________ ___________________________________
Telephone number (include area code) FAX number (include area code)
__________________________________________ _________________________________________________
E-mail address Website
6. If the appraisal management company is located outside of New Jersey, an agent for service of process in New Jersey must be provided.
Name of agent: ___________________________________________________________________________________________
___________________________________________________________________________________________
Street address City State ZIP code
__________________________________ _________________________________________________
Telephone number (include area code) E-mail address
7. Has this company been issued an appraisal management company registration in New Jersey previously? Yes No
If “Yes,” provide the registration number: ________________________________________________
8. Is the appraisal management company registered in another state or jurisdiction? Yes No
If “Yes,” list the state(s) or jurisdictions(s) and registration number:
State/Jurisdiction Registration number
__________________________________________ ______________________________________
__________________________________________ ______________________________________
B. Compliance Ofcer
Provide the following information for the compliance ofcer of the appraisal management company responsible for the certication of
this application.
Name of compliance ofcer: ________________________________________________________________________________
___________________________________________________________________________________________________
Street address City State ZIP code
___________________________________ _________________________________________________
Telephone number (include area code) E-mail address
___________________________________ __________________________________________
Appraiser license/certication number (if applicable) State that issued license/certication
C. Controlling Person(s)
Each controlling person, as dened by N.J.A.C. 13:40A-9.2, must be reported to the Board. Please attach additional sheets if you have
more than one (1) controlling person to report.
Name of controlling person _________________________________________________________________________________
___________________________________________________________________________________________________
Street address City State ZIP code County
___________________________________________________________________________________________________
P.O. Box City State ZIP code County
___________________________________ _________________________________________________
Telephone number (include area code) E-mail address
This controlling person is a(n): Check all that apply.
Ofcer
Director
Owner of greater than 10% interest (Indicate % of ownership interest here ________ )
Individual employed, appointed or authorized to enter into contracts or agreements
Individual who possesses power to direct managements or policies
D. Designated Contact Person
One controlling person must be designated as the main contact for communication between the appraisal management company and the
Board. Please be advised that this controlling person shall not be the designated contact for more than one appraisal management company
at any given time. Provide the name of the one controlling person who is the designated contact person for the appraisal management
company.
Name of contact person: ___________________________________________________________________________________
E. Disciplinary Action History - Appraisal Management Company
1. Has the appraisal management company ever been disciplined for any reason in any state or jurisdiction? Yes No
2. Has the appraisal management company ever been notied it was under investigation in any state or jurisdiction?
Yes No
3. Has the appraisal management company ever been refused or denied an appraisal management company registration in any state or
jurisdiction? Yes No
4. Is the appraisal management company the subject of any unsatised judgments? Yes No
5. Is the appraisal management company the subject of any nal or pending civil suits or criminal actions in any state or jurisdiction?
Yes No
If the answer to any of the questions in section E is “Yes,” list the state or jurisdiction and the corresponding registration number of
the appraisal management company.
State/Jurisdiction Registration number
__________________________________________ ______________________________________
__________________________________________ ______________________________________
F. Disciplinary Action History – Compliance Ofcer, Controlling Person(s), and all Owner(s) (including those who own 10%
or less interest in the appraisal management company).
1. Have any of the controlling person(s), owner(s), or compliance ofcer ever had an appraiser license, certication or temporary
practice permit refused, denied, cancelled, surrendered in lieu of revocation, or revoked in New Jersey, any other state, the District
of Columbia or in any other jurisdiction? Yes No
2. Are there any investigations now pending against the professional license, certicate, permit, or registration, issued to any of the
controlling person(s), owner(s), or compliance ofcer by a professional Board in New Jersey, any other state, the District of Columbia,
or in any other jurisdiction? Yes No
3. Are there any actions now pending against any of the controlling person(s), owner(s), or compliance ofcer by any employer,
association, society, or other professional group related to the practice of real estate appraisal in New Jersey, any other state, the
District of Columbia, or in any other jurisdiction? Yes No
If the answer to any of the questions in section F is “Yes,” provide the name(s) of the person, license/certication number, and state
that issued license/certication.
Name License/Certication number State that issued license/certication
_________________________________ _________________________________ _______________________________
_________________________________ _________________________________ _______________________________
G. Criminal History – Controlling Person(s)
1. Have any of the controlling persons ever been taken into custody, arrested, summoned, formally accused, charged, or indicted for
any violation of law, ordinance, felony, crime, misdemeanor, or disorderly persons offense, whether municipal, state, federal, or in
other countries? (Driving While Intoxicated/Impaired and Driving Under the Inuence must be disclosed.) Yes No
2. Have any of the controlling persons ever been convicted of any violation of law, ordinance, felony, crime, misdemeanor, or disorderly
persons offense, whether municipal, state, federal, or in other countries? This includes, but is not limited to, a plea of guilty, non
vult, nolo contendere, no contest, or a nding of guilt by a judge or jury. (Driving While Intoxicated/Impaired and Driving Under
the Inuence must be disclosed.) Yes No
} ss.
Afx seal here.
Certication of Compliance Ofcer
In accordance with N.J.A.C. 13:40A-9.4(b), the application for registration as an appraisal management company certication must be
completed by the compliance ofcer of the appraisal management company.
State of: _______________________________________
County of: _____________________________________
I, _____________________________________________ , in making this application to the State Real Estate Appraiser Board for appraisal
management company registration under the provision of Title 45, Chapter 14F of the General Statutes of New Jersey and Title 13, Chapter
40A of the Rules of the State Real Estate Appraiser Board, certify that I am the compliance ofcer of the appraisal management company.
I certify that all of the information provided in connection with this application is true to the best of my knowledge and belief. I understand
that any omissions, inaccuracies, or failure to make full disclosures may be deemed sufcient to deny registration or to withhold renewal
of, or suspend or revoke a registration issued by the Board.
I certify that the appraisal management company has a system and process in place to verify that a person being added to the appraiser
panel of the appraisal management company holds a license or certication in good standing in the State of New Jersey.
I certify that the appraisal management company requires appraisers completing appraisals, including, but not limited to, appraisals and
appraisal reviews, at its request to comply with the Uniform Standards of Professional Appraisal Practice (USPAP) promulgated by the
Appraisal Standards Board of the Appraisal Foundation, including the requirements for geographic and product competence.
I certify that the appraisal management company has a system in place to verify that only licensed or certied appraisers are used for
Federally related transactions.
I certify that the appraisal management company has a system in place to require that appraisals are conducted independently and free
from inappropriate inuence and coercion as required by the appraisal independence standards established under the Federal Truth in
Lending Act, Pub. L.90-321 (15 U.S.C. § 1639e), including the requirements for payment of customary and reasonable compensation to
fee appraisers when the appraisal management company is providing services for a consumer credit transaction secured by the principal
dwelling of a consumer.
I certify that the appraisal management company maintains a detailed record of each service request that it receives and the name of the
appraiser that performs the real estate appraisal services for the appraisal management company.
I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are willfully
false, I am subject to punishment.
___________________________________ ___________________________________ _______________________
Name of compliance ofcer (please print) Signature of compliance ofcer Date
Sworn and subscribed to before me this ______________
day of ____________________________ , 20 ________
Month Year
______________________________________________
Name of Notary Public (please print)
______________________________________________
Signature of Notary Public
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New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Real Estate Appraiser Board
124 Halsey Street, 3rd Floor, P.O. Box 45032
Newark, New Jersey 07101
(973) 504-6480
CertifiCation and authorization form
f
or a Criminal history BaCkground CheCk
Directions: Answer all of the questions on this form.
1. Name _________________________________________________________ ( _________________________)
Last First Middle Maiden Name
2. Address ___________________________________________________________________________________________
Street or P.O. Box City State ZIP code
3. Date of birth __ __ /__ __ /__ __ Sex: Male Female
Month Day Year
4. Social Security number _________/ _____ / ________
5. Have you completed the ngerprinting process for any Board or Committee of the New Jersey Division of Consumer
Affairs since November 2003?
Yes No
If “No,” you will receive a separate mailing from the Board or Committee regarding the criminal history background process.
Please send no payment now.
If “Yes,” please provide the following information and follow the instructions outlined below:
_______________________________________________ _______________________________________________
Board or committee requiring the ngerprinting Month and year you were ngerprinted
If you were ngerprinted after November 2003 as part of the criminal history background process for licensure or
certication by any other any other Board or Committee of the New Jersey Division of Consumer Affairs (a background
check conducted for the Department of Education, another state agency or another state does not apply) you will not be required
to be ngerprinted a second time. However, the Division must perform a criminal history background check each time you
apply for licensure or certication. The fee for this service is $18.75. Payment should be made in the form of a check or
money order payable to the State of New Jersey and should accompany your application packet.
6. Have you ever been arrested and/or convicted of a crime or offense? (Minor trafc offenses such as a parking or speeding
violations need not be listed.)
Yes No
Every such conviction on record must be disclosed. A true copy of every police report, judgment of conviction, sentencing
order and termination of probation order, if applicable, must be submitted with this form. Any documents (including employer
or supervisor letters of reference, if applicable) which present clear and convincing evidence of rehabilitation must be submitted
with this form. Failure to follow these instructions may result in the denial of an initial application.
Note: Copies of judgments, sentencing and termination of probation orders may be obtained from the clerk of the county
where those orders, disposing of the conviction, were issued and led.
Your continuing responsibility to disclose convictions of crimes or offenses: You must notify the Board or Committee
within ve (5) business days if you are convicted of any crimes or offenses after this form has been completed.
Mr.
Mrs.
Ms.
Ofcial Use Only
Dual License
License Type 1
_____________________
Applicant’s Number
_____________________
License Type 2
_____________________
Applicant’s Number
_____________________
Ofcial Use Only
Resubmit
______________________
Board or Committee
______________________
Rev. 1/1/19
CertifiCation
I, ______________________________________________, in making this application to the Board or Committee for
certication, licensure or registration certify that I am the applicant and that all of the information provided in connection with this
application is true to the best of my knowledge and belief. I understand that any omissions, inaccuracies or failure to make full
disclosures may be deemed sufcient to deny certication, licensure or registration or to withhold renewal of, or suspend or revoke
a certicate, license or registration issued by the Board or Committee.
I voluntarily consent to a thorough investigation of my present and past employment and other activities for the purpose
of verifying my qualications for certication, licensure or registration. I further authorize all institutions, employers, agencies
and all governmental agencies and instrumentalities (local, state, federal or foreign) to release any information, les or records
requested by the Board or Committee.
I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are
willfully false, I am subject to punishment.
_______________________________________________ __________________________________
Signature of applicant Date
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Application for Registration as an Appraisal Management Company (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Completed 15 August 2020

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