DOUGLAS A. DUCEY
GOVERNOR
JUDY LOWE
COMMISSIONER
form COM-102 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 AFFIDAVIT
(Respondent Notarized and Broker Signature)(COM-102)
I,_____________________________, Designated Broker for the above named Respondent have reviewed this Affidavit.
Designated
Broker Date
Designated Broker signature is not notarized.
*For more information or questions visit www.azre.gov
License #_________________
Licensee Name:________________________
Consent Order dated ________________
i.e. =year F-DI-000 Commissioner’s Signature Date
I, ____________
_________________, hereby affirm that since the entering of the above Consent Order:
_____
_I have co
mplied with all of the terms and conditions set forth in the above Consent Order.
initials
______I have not
violated any provision of the Title 32, Chapter 20 of the Arizona Revised Statutes.
Initials
______I have not
violated any provision of the Title 4, Chapter 28 of the Arizona Administrative Code (Commissioner’s Rules).
initials
I declare under
the penalty of perjury that the above statements are true. I agree to maintain the original signed
Affidavit for 5 years.
_____________________
_________ ____________
Respondent’s Signature Date
State of Arizona
County of _____________
The foregoing instrument was acknowledged before me, _________________, this ______ day of __________, ______,
by__________________________.
My commission expires: ___________________ _____________________________________________
NOTARY PUBLIC
Consent Order Number:
______________
Print Name of Respondent
