Fillable Application to Change License Status (Alaska Department of Commerce, Community, and Economic Development)

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Application to Change License Status (Alaska Department of Commerce, Community, and Economic Development)

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Application to Change License Status
ALL APPLICANTS
Complete all biographical and affidavit of applicant information, even if there has been no change since your last application.
Social security numbers must be provided per AS 08.01.060(b) and AS 08.01.100.
Include the appropriate fees. Your application will not be processed until the fees are receipted. The fee schedule is on page 2.
There is no charge for changes of biographical information unless you are requesting a new license certificate.
If you request a name change, provide copies of legal documentation. The fee is $75 for a new license certificate.
If your completed application is submitted in advance of a requested effective date, the action will be completed on the date
requested. Otherwise, it will be effective on the date all necessary paperwork and fees are received.
Transfer or Inactivation AS 08.88.251 and 12 AAC 64.075
When you transfer from an office or inactivate your license, the terminating broker:
1. signs and dates the face of your license;
2. photocopies the signed license and gives the photocopy to you to take to your new employing broker;
3. completes the terminating broker portion of the application form; and
4. mails or emails the license to the real estate licensing examiner at the Anchorage address on the application or via email at
RealEstateCommission@Alaska.Gov.
When you transfer into an office, the employing broker:
1. receives the photocopy of the signed and dated license;
2. completes the employing broker portion of the application form;
3. submits proof/verification of E & O Insurance coverage;
4. displays the photocopy until the reissued license giving the current employing broker's name is received from the Commission;
5. recognizes the photocopy as a valid license for no more than 30 days from the date of the previous broker's signature.
License Reactivation AS 08.88.251(c)
A current inactive license may be reactivated without retesting at any time during the two-year inactive period by completing the
biographical information, affidavit of applicant, and employing broker information; and paying the appropriate fee.
License Reinstatement AS 08.88.091, AS 08.88.095, AS 08.88.241, AS 08.01.100, 12 AAC 64.064,12 AAC 64.071, 12 AAC 64.500,
02.360(a)(11)
When either an active or inactive license is not renewed in January of even-numbered years and/or Post Licensing Education (PLE) was not
completed within one year from initial date of licensure, the license lapses.
A license that was not renewed may be reinstated without retesting prior to the date printed on the inactive license certificate or
the next renewal, whichever is earlier.
A license that lapsed due to noncompliance of PLE will be reinstated only when the required PLE is completed and all required
documents for reinstatement are received by the Real Estate Commission.
A lapsed license will only be reinstated as an active license, per 12 AAC 64.071(e). Documents required for reinstatement of a lapsed license
are:
completed application to reinstate on the Change License Status form;
proof of necessary continuing education and/or
proof of necessary post licensing education
submits proof/verification of E & O Insurance coverage
appropriate fees, to include a $225 reinstatement fee.
Broker Termination of Licensee AS 08.88.171(c) and 12 AAC 64.075
Complete the “Terminating Broker Notice to Real Estate Commission.”
Sign and date the face of the license certificate.
Return both the form and the license certificate to the Commission office via mail or email; no fee is necessary.
08-4076 (Rev. 9/9/2021) Application Instructions Page 1 of 1
Real Estate Commission
550 West 7th Avenue, Suite 1500, Anchorage, AK 99501
Phone: (907) 269-8160
Email: RealEstateCommission@Alaska.Gov
Website: ProfessionalLicense.Alaska.Gov/RealEstateCommission
T
HE
S
TATE
ALASKA
of
Department of Commerce, Community, and Economic Development
Division of Corporations, Business and Professional Licensing
ERRORS AND OMISSIONS INSURANCE
All licensees are required to obtain and submit proof of E & O Insurance, either through the Master Policy offered by RISC or through
equivalent coverage. All licensees are required to submit verification that they have met the E & O requirement.
POST LICENSING EDUCATION
All new licensees are required to complete 30 hours of post-licensing education (PLE). This education must be completed within one
year after the date of initial salesperson or broker licensure. This is in addition to the 20 hours of continuing education that you must
complete to renew your license. After the required 30 hours of PLE is completed an Affidavit of Post Licensing Affidavit form (08-4326)
MUST be submitted to the Real Estate Commission. Copies of all certificates of the completed education and appropriate fees must
accompany the PLE Affidavit within 30 days after the 1-year period of initial licensure [AS 08.88.095] or the license will lapse. New
licensees applying for licensure by endorsement who hold an active and valid real estate license in another state and have been
licensed by that state for 1 year or more are NOT required to complete PLE [AS 08.88.263(3)]. Additional information about post-
licensing requirements is available on the Commission’s web site at
ProfessionalLicense.Alaska.Gov/RealEstateCommission
APPLICATION PROCESSING
The average time to process a paper application varies by program but can take several weeks from the date it is received in this office
complete with all correct forms, supporting documents and appropriate fees paid. When the application is complete and correct, and
all supporting documents have been received and all fees have been paid, the license will be issued and sent to you. Start the process
far enough in advance to allow for processing time. Applications are reviewed in order of receipt in our office, and walk-in customers
should not expect immediate review.
LICENSE TERM
There is no “inactive” status. If you choose not to renew your license, it will lapse. Licenses are issued for a two-year period and expire
on August 31 of odd-numbered years, regardless of the date of issuance, except licenses issued within 90 days of the expiration date
are issued to the next biennial expiration date. One renewal notice will be mailed at least 30 days before license expiration to the last
known address of record.
“YES” RESPONSES
A “Yes” response in the application does not mean your application will be denied. If you have responded “Yes” to any professional
fitness questions in the application, be sure to submit a signed and dated explanation, and the charging document and judgement.
DENIAL OF APPLICATION
Please be aware that the denial of an application of licensure may be reported to any person, professional licensing board, federal,
state, or local governmental agency, or other entity making a relevant inquiry or as may be required by law.
RANDOM AUDIT
If your program requires continuing education, the Division will audit a percentage of the license renewals. If your license is randomly
selected for audit, a letter will be sent with instructions to submit documentation as proof you satisfied the continuing competency
requirements as stated on this renewal form. Licensees are randomly selected by computer and may be randomly selected as often
as the computer program chooses. You must save your documents for at least four years so you can respond to audits.
ADDRESS OR NAME CHANGE
In accordance with 12 AAC 02.900, it is the applicant's/licensee's responsibility to notify the Division, in writing, of changes of address
or name. Name and address change notification forms are available on the Division’s website. The address of record with the division
will be used to send renewals and all other official notifications and correspondence. The name appearing on the license must be your
current legal name.
SOCIAL SECURITY NUMBERS
In accordance with AS 08.01.060, the department is not authorized to issue a license to a natural person, unless the applicant’s Social
Security Number has been provided to the department. If you are a foreign citizen unable to obtain a United States Social Security
Number, please contact the division for further instructions or obtain the Exception from SSN Requirement form (#08-4372), from the
division website at ProfessionalLicense.Alaska.Gov
08-4076 (Rev. 9/9/2021) General Information Page 1 of 2
General Information
PUBLIC INFORMATION
Please be aware that all information on the application form will be available to the public, unless required to be kept confidential by
state or federal law. Information about current licensees, including mailing addresses, is available on the division’s website at
ProfessionalLicense.Alaska.Gov under License Search.
ABANDONED APPLICATIONS
Under 12 AAC 02.910, an application is considered abandoned when 12 months have elapsed since correspondence was last received
from or on behalf of the applicant. An abandoned application is denied without prejudice. At the time of abandonment, the division
will send notification to the last known address of the applicant, who has 30 days to submit a written request for a refund of biennial
license and other fees paid. The application fee will not be refunded. If no request for refund is received within that timeframe, no
refund will be issued, and all fees will be forfeited.
STATUTES AND REGULATIONS
The complete set of statutes and regulations for this program are available by written request or online at the Commission’s website:
ProfessionalLicense.Alaska.Gov/RealEstateCommission
If you would like to receive notice of all proposed regulation changes for your program, please send a request in writing with your name,
preferred contact method (mail or email), and the specific program you want to be updated on to the address below.
Regulations Specialist
Department of Commerce, Community, and Economic Development
Division of Corporations, Business and Professional Licensing
EMAIL: RegulationsAndPublicComment@Alaska.Gov
08-4076 (Rev. 9/9/2021) General Information Page 2 of 2
Alaska Real Estate Commission Fee Schedule – Licensee Actions
Type of License Action
Fee Amounts
Application License
Recovery
Fee
Reinstatement
Fee
Change Total
New Alaska License
$200 $140 $50
$390
Changes to Current Licenses
Transfer of License $225 $225
Active to Inactive $150 $150
Inactive to Active (for current licensing period) $150 $150
Change Name on License
(attach copy of legal documentation)
$75 $75
Completion of PLE (attach affidavit and PLE certificate) $50 $50
Miscellaneous Fees
Inactive to Active (if renewed inactive) $50 $150 $200
Reinstatement of Lapsed License
(non-compliance of PLE)
$50 $225 $275
Reinstatement of Lapsed License (did not renew) $140 $50 $225 $415
Reinstatement of Lapsed License – Prorated
(02/01/19-11/02/19) (did not renew)
$70 $50 $225 $345
Reactivation of Lapsed License from an inactive status
(did not renew inactive)
$140 $50 $150 $340
All Other Biographical Information (change of residence
address, phone #, etc, must be submitted in writing)
$0 $0
Replacement License (duplicate) $20 $20
License History $20 $20
NSF Check Penalty Fee $20 $20
Roster $15 $15
08-4076 (Rev. 9/9/2021) Fee Schedule Page 1 of 1
Application to Change License Status
PART I
Status Change
Associate Broker to Broker
Broker to Branch Office
Broker to Associate Broker
Broker to New Office Located at Same Address
PART II
Payment of Fees
Current Licenses
(Check One):
Transfer License (12 AAC 64.075)
$225.00
Inactivate License (AS 08.88.251)
$150.00
License Fee – same office
$ 20.00
Post Licensing
Education:
Affidavit and PLE (ZSU)
$ 50.00
Reactivate License:
Inactive to Active - If Renewed with Inactive Status
REC - $150, ZSU- $50
$200.00
Inactive to Active – for current licensing period
$150.00
Lapsed Inactive – did not renew
REC
-
$290, ZSU
-
$50
$340.00
Reinstate License:
Lapsed – did not renew
REC
-
$365, ZSU
-
$50
$415.00
Lapsed – did not renew (Prorated – Initial issue from 02/01/19- 11/02/19)
REC
-
$295, ZSU
-
$50
$345.00
Lapsed – Non-compliance of PLE
REC - $225, ZSU - $50
$275.00
08-4076 (Rev. 9/9/2021) Application to Change License Status Page 1 of 7
REC
Real Estate Commission
550 West 7th Avenue, Suite 1500, Anchorage, AK 99501
Phone: (907) 269-8160
Email: RealEstateCommission@Alaska.Gov
Website: ProfessionalLicense.Alaska.Gov/RealEstateCommission
Applicant Name:
License Number:
Current License Type:
Salesperson Associate Broker Broker
T
HE
S
TATE
ALASKA
of
Department of Commerce, Community, and Economic Development
Division of Corporations, Business and Professional Licensing
FOR DIVISION USE ONLY
PART III
Applicant Information
Full Legal Name:
Provide all other names used (maiden, nicknames, aliases). Attach documentation of all legal name changes.
Not Applicable
Other Names Used:
If any documentation will be received in a prior name, you must provide a certified true copy of the documentation showing
proof of legal name change(s).
Mailing Address:
Birth Date:
(mm/dd/yyyy)
Contact Phone:
EMAIL AGREEMENT: By choosing to receive correspondence on any matter affecting my license or other business with the Alaska Division of Corporations, Business
and Professional Licensing, I agree to maintain an accurate email address through the MY LICENSE web page. I understand that failure to check my email account or
to keep the email address in good standing may result in an inability to receive crucial information, potentially resulting in my inability to obtain or maintain licensure.
Email Address:
Send my Correspondence by Email
Send my Correspondence by US Mail
SOCIAL SECURITY NUMBER: AS 08.01.060 requires you to provide your United States
Social Security Number. It is considered confidential information and will not be
publicly disclosed; it may be used to verify inter-state licensure.
PART IV
ListServ
Would you like to be placed on the AREC ListServ to receive Commission news via email?
Yes
No
If yes, please provide the email you would like registered with the ListServ:
PART V Professional Fitness Questions
The following professional fitness questions must be answered.
“Yes” answers may not automatically result in license denial. If you answer “Yes” to any of the questions, please explain dates and
specific circumstances (locations, type of action, organizations or parties involved) on a separate piece of paper, signed and dated,
and send any supporting documents that are applicable (court records, judgments, charging documents, certificates of completion,
board or license actions, investigative notices, etc.).
Applications submitted without the appropriate attachments will be considered incomplete and will not be processed.
The contents of licensing files are generally considered public records. If you believe that the additional information you are
attaching to explain a “yes” answer should be considered confidential, state that in the attachment. A request for confidentiality
may or may not be granted.
When in doubt, disclose and explain.
Since the date your last Alaska license was issued or renewed:
1. Have you ever been convicted of a crime or are you currently charged with committing a crime? For the
purpose of this question, “crime” includes a misdemeanor, felony, or a military offense. “Convicted” includes
having been found guilty by verdict of a judge or jury, having entered a plea of guilty, nolo contendere, or no
contest, or having been given probation, a suspended imposition of sentence (SIS), or a fine.
Yes
No
2. Have you ever had a real estate license revoked, denied, suspended, surrendered, placed on probation, or
subject of any restriction, censure, reprimand, consent agreement or any other disciplinary or license action?
Yes
No
3. Have you ever had any other professional or occupational license revoked, denied, suspended, surrendered,
placed on probation, or under any restriction, censure, reprimand, or any other disciplinary or license action
in the state or any other jurisdiction?
Yes
No
08-4076 (Rev. 9/9/2021) Application to Change License Status Page 2 of 7
4. Have you ever had a fidelity bond denied or revoked?
Yes
No
5. Are you the subject of an unresolved complaint or disciplinary action before a real estate regulating
authority or a professional real estate association?
Yes
No
6. Have you ever had a lawsuit filed against you alleging deceit, fraud, misrepresentation or conversion of
funds?
Yes
No
7. Have you attached required documentation for any “Yes” answers for questions 1 - 7?
(Check “No” if you have not answered yes to any question.)
Yes
No
12 AAC 02.530. STANDARDS FOR EQUIVALENT COVERAGE. An insurer issuing equivalent coverage under AS 08.88.172(c)(2) shall hold
a certificate of authority issued under AS 21.09. All activities contemplated under AS 08.88.172 must be covered. The insurance must
meet the minimum coverage standards of 12 AAC 02.510, except that
(1) a policy with a higher deductible amount or self-insured retention will qualify as equivalent coverage for purposes of AS
08.88.172(c)(2) if, when applying to obtain or renew the license, the insured licensee provides the Real Estate Commission
with
(A) an affidavit certifying that the insured licensee has the financial resources in set-aside funds to pay the higher deductible
amount or self-insured retention; and
(B) a certificate of insurance from the insured licensee's insurer; and
a broker employing other real estate licensees may comply with the requirements of 12 AAC 02.510(a)(1) and (2), by obtaining
insurance with coverage of a minimum of $300,000 per wrongful act and $1,000,000 aggregate, if all licensees associated with the
broker are covered.
08-4076 (Rev. 9/9/2021) Application to Change License Status Page 3 of 7
PART VI
Proof of Errors & Omissions Insurance
All licensees are required to obtain and submit proof of E & O insurance, either through the master policy offered by RISC or through
equivalent coverage. Those licensees who choose to obtain E & O insurance through equivalent coverage will be required to submit
a form completed by their insurance provider that certifies the licensee has met the E & O requirements per 12 AAC 02.510.
CHECK THE BOX THAT APPLIES:
I have obtained coverage through the master policy offered by RISC.
I have an E & O insurance policy with a deductible of NOT MORE THAN $5,000; and
I have attached or submitted a certificate of insurance from my insurance provider.
I have an E & O insurance policy with a deductible of MORE THAN $5,000 or self-insured retention; and
I have attached or submitted a notarized affidavit certifying that I have financial resources in set-aside funds to pay the
higher deductible amount or self-insured retention; and
I have attached or submitted a certificate of insurance from my insurance provider.
Per 12 AAC 02.530(2), a broker of other real estate licensees may comply with the requirements of 12 AAC 02.510(a)(1) and (2) by
obtaining insurance with coverage of a minimum of $300,000 per wrongful act and $1,000,000 aggregate, if all licensees
associated with the broker are covered.
I have E & O insurance coverage through my real estate brokerage.
I have attached or submitted a certificate of insurance from the insurance provider.
My license is in inactive status and E & O insurance is not required until I reactivate my license.
Signature Page
08-4076 (Rev. 9/9/2021) Application to Change License Status Page 4 of 7
REC
Real Estate Commission
550 West 7th Avenue, Suite 1500, Anchorage, AK 99501
Phone: (907) 269-8160
Email: RealEstateCommission@Alaska.Gov
Website: ProfessionalLicense.Alaska.Gov/RealEstateCommission
Applicant Name:
PART VII
Agreement
I hereby certify that I am the person herein named and subscribing to this application and that I have read the complete
application, and I know the full content thereof. I declare that all of the information contained herein, and evidence or
other documents submitted herewith are true and correct.
I understand that any falsification or misrepresentation of any item or response in this application, or any attachment
hereto, or falsification or misrepresentation of documents to support this application, is sufficient grounds for denying,
revoking, or otherwise disciplining a license, certificate, or permit to practice in the state of Alaska.
I further understand that it is a Class A misdemeanor under Alaska Statute 11.56.210 to falsify an application and commit
the crime of unsworn falsification.
Applicant’s Signature: Date:
T
HE
S
TATE
ALASKA
of
Department of Commerce, Community, and Economic Development
Division of Corporations, Business and Professional Licensing
FOR DIVISION USE ONLY
Employing Broker Information
PART I
Business Information (Required)
Business Name
(Print):
Real Estate Office
License Number:
Business Mailing
Address:
PART II
Broker Information (Required)
Employing Broker’s
Name (Print):
Broker License
Number:
Broker Phone
Number:
Broker Signature: Date:
PART III
Associate Broker Information (Required only if working in a branch office)
Associate Broker
Name (Print):
Associate Broker
License Number:
Associate Broker
Signature:
Date:
08-4076 (Rev. 9/9/2021) Application to Change License Status Page 5 of 7
Real Estate Commission
550 West 7th Avenue, Suite 1500, Anchorage, AK 99501
Phone: (907) 269-8160
Email: RealEstateCommission@Alaska.Gov
Website: ProfessionalLicense.Alaska.Gov/RealEstateCommission
Applicant Name:
T
HE
S
TATE
ALASKA
of
Department of Commerce, Community, and Economic Development
Division of Corporations, Business and Professional Licensing
Terminating Broker Information
PART I
Business Information (Required)
Business Name
(Print):
Real Estate Office
License Number:
Business Mailing
Address:
PART II
Broker Information (Required)
Broker Name
(Print):
Broker License
Number:
Broker Phone
Number:
Broker Signature: Date:
PART III
Associate Broker Information (Required only if working in a branch office)
Associate Broker
Name (Print):
Associate Broker
License Number:
Associate Broker
Signature:
Date:
08-4076 (Rev. 9/9/2021) Application to Change License Status Page 6 of 7
Real Estate Commission
550 West 7th Avenue, Suite 1500, Anchorage, AK 99501
Phone: (907) 269-8160
Email: RealEstateCommission@Alaska.Gov
Website: ProfessionalLicense.Alaska.Gov/RealEstateCommission
Applicant Name:
T
HE
S
TATE
ALASKA
of
Department of Commerce, Community, and Economic Development
Division of Corporations, Business and Professional Licensing
Broker Notice to Real Estate Commission of Licensee Termination
PART I
Licensee Information
Name of Licensee:
First Middle
Last
License Number:
Office Terminated From:
Date Terminated:
Dates Affiliated
with Office:
From: _______________________ To:__________________________
Reason for Termination:
Transferring to another office
Inactivating license
Unable to locate licensee
Lapsed license due to noncompliance of Post Licensing Education (PLE)
Disciplinary action by broker (attach explanation)
Other (attach explanation)
PART II
Broker Signature
I understand that I am responsible for listings and transactions that have been generated by this licensee and which are still
pending. I further understand that no transactions submitted by this licensee and dated later than the above date will be attributed
to my office or subject to my supervision.
Broker Name (Print):
Broker Number:
Broker Signature: Date:
08-4076 (Rev. 9/9/2021) Application to Change License Status Page 7 of 7
Real Estate Commission
550 West 7th Avenue, Suite 1500, Anchorage, AK 99501
Phone: (907) 269-8160
Email: RealEstateCommission@Alaska.Gov
Website: ProfessionalLicense.Alaska.Gov/RealEstateCommission
T
HE
S
TATE
ALASKA
of
Department of Commerce, Community, and Economic Development
Division of Corporations, Business and Professional Licensing
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Completed 7 February 2022

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