DOUGLAS A. DUCEY
GOVERNOR
JUDY LOWE
COMMISSIONER
Form COM-302 rev 6-11-2018
Arizona Department of Real Estate (ADRE)
Enforcement & Compliance Division
www.azre.gov
100 North 15
th
Avenue, Suite 201, Phoenix, Arizona 85007
COMPLIANCE - PRACTICE MONITOR ACCEPTANCE
(Designated Broker’s Signature) (COM-302)
Respondent: ________________________________
Print Name of Respondent
Consent Order Number: _______________________ Consent Order dated: _____________________
i.e.= yearF-DI-OOO Commissioner’s Signature Date
I, ________________________, am the Designated Broker of ________________________________
Print Broker’s Name Name of Brokerage
I hereby affirm that:
_____ I agree to be the practice monitor for the above named respondent.
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_____ I have read and understand the terms and conditions of the Consent Order.
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_____ I have not been party to any prior disciplinary action by the Department.
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_____ I am not a relative, business partner, or co-owner in any business enterprise with the Respondent.
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There is no relationship with the Respondent that may create, or create the appearance of, a conflict
of interest or bias.
_____ I
understand that I am required to review, sign and have notarized the respondent’s quarterly
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statements to the Department.
_____ I understand that during the term of the Consent Order, the Respondent may not be a supervisor,
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branch manager, partner, owner, co-owner, member or officer of any entity licensed under Title 32,
Chapter 20, Arizona Revised Statutes.
_____ My status as Practice Monitor is subject to review and approval by the Department and approval may
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be withdrawn at any time upon written notice from the Department.
_____ I will immediately notify the Department in writing if I become aware of any behavior or conduct by
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the Respondent that violates real estate statutes or the terms of the Consent Order.
_____ I will immediately notify the Department if the Respondent leaves my employ or if I am no longer able
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to act as the Respondent’s practice monitor.
______________________________ __________________
Print Name of Designate Broker Broker's License Number
______________________________ _________
Signature of Designated Broker Date
*For more information or questions visit www.azre.gov
RESPONDENT MUST MAINTAIN THE ORIGINAL OF THIS FORM FOR 5 YEARS.
