DOUGLAS A. DUCEY
GOVERNOR
JUDY LOWE
COMMISSIONER
form COM-103 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
(Property Management Respondent Notarized) (COM-103)
Licensee Name: _______________________________ License Number: _____________________
Print Name of Respondent
Consent Order Number: _______________________ Consent Order dated: _____________________
i.e. =yearF-DI-000 Commissioner’s Signature Date
I,_____________________________, hereby affirm that since the entering of the above Consent Order:
____I have c
omplied 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
Property Management Activity
Number of trust accounts maintained: ____
I have reviewed and approved the monthly bank account and trust account reconciliations.
My trust account(s) is/are in balance; if not enter amount: Overfunded $_______ Underfunded $_______
Number of employees involved in property management activities: ____licensed ____non-licensed
Number of clients:
End of last period____ End of current period____ Change____
Number of properties managed:
End of Last period____ End of Current period____ Change____
Have you received a complaint from any client(s) alleging failure to remit monies due? No____ Yes____
(if yes explain on a separate page)
Describe any changes in your property management business: __________________________________
_____________________________________________________________________________________
I declare under the penalty of perjury that the above statements are true. Original form must be maintained 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
*For
more information or questions visit www.azre.gov
