Fillable Arizona Department of Real Estate (ADRE) USE OF (Arizona Department of Real Estate)

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Arizona Department of Real Estate (ADRE) USE OF (Arizona Department of Real Estate)

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Arizona Department of Real Estate (ADRE)
Auditing and Investigations Division
www.azre.gov
100 North 15th Avenue, Suite 201, Phoenix Arizona 85007
DOUGLAS N. DUCEY
GOVERNOR
JUDY LOWE
COMMISSIONER
AUD 102 Offsite / Electronic Storage Notification Form 07-25-2015
USE OF OFFSITE STORAGE / ELECTRONIC STORAGE / ELECTRONIC MANAGEMENT SYSTEMS
Submit completed form and attachments to the Department through the Department Message Center Click Here1
1. EMPLOYING BROKER / ENTITY INFORMATION:
Designated Broker (DB) or Self-Employed Broker (SE) Name (print as appears on license):
DB or SE License Number:
Employing Broker / Entity Name:
Employing Broker / Entity License Number:
Employing Broker / Entity Physical Address:
Suite:
City:
State:
Zip:
Employing Broker / Entity Mailing Address: Same as Physical Address
Suite:
City:
State:
Zip:
Employing Broker / Entity FAX
DB or SE Email Address:
2. OFFSITE STORAGE LOCATION FOR HARD COPY (PAPER) FILES (A.R.S. §§ 32-2151.01.A; 32-2175.A; 32-2175.C):
Records are stored at Broker’s Home Commercial Storage Facility
Name of Commercial Storage Facility:
Physical Address:
Suite:
City:
State:
Zip:
Name of Statutory Agent (Out-of-State Brokers Only) (A.C.C. R4-28-302.L)
Name of Law Firm (if applicable):
Physical Address:
Suite:
City:
State:
Zip:
3. ELECTRONIC RECORDS STORAGE (A.R.S. § 32-2151.B.2):
Records are stored: Broker’s Computer System With Third-Party Vendor
Name of Third Party Vendor:
Business Address of Third Party Vendor:
Suite:
City:
State:
Zip:
Broker Maintains a back-up of Electronic Files to allow reconstruction if electronic data is destroyed (A.R.S. § 32-2151.B.2): Yes No
4. ELECTRONIC MANAGEMENT SYSTEM (TRANSACTION AND FINANCIAL RECORDS) (ADRE SPS No. 2010.01):
Employing Broker Utilizes: Electronic Transaction Management System
Name of Electronic Transaction Management System:
Business Address of Electronic Transaction Management System Vendor:
Suite:
City:
State:
Zip:
Employing Broker Utilizes: Property Management Financial Software
Name of Property Management Financial Software:
Business Address of Property Management Financial Software Vendor:
Suite:
City:
State:
Zip:
Broker Maintains a back-up of Electronic Files to allow reconstruction if electronic data is destroyed (A.R.S. § 32-2151.B.2): Yes No
Broker’s Signature Date
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Arizona Department of Real Estate (ADRE) USE OF (Arizona Department of Real Estate)

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Completed 12 August 2020

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