Fillable BUSINESS BROKER PERMIT INSTRUCTIONS (Nevada Real Estate Division)

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BUSINESS BROKER PERMIT INSTRUCTIONS (Nevada Real Estate Division)

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STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 * (702) 486-4033
e-mail: realest@red.nv.gov * http://red.nv.gov/
Revised 12/11/18 Page 1 of 5 Form 624
BUSINESS BROKER PERMIT INSTRUCTIONS
LIMITED TO A NEVADA REAL ESTATE LICENSEE
NRS 645.0075 “Business broker” defined. “Business broker” means a person who, while acting as a real estate broker, real estate
broker-salesman or real estate salesman for another and for compensation or with the intention or expectation of receiving
compensation:
1. Sells, exchanges, options or purchases a business;
2. Negotiates or offers, attempts or agrees to negotiate the sale, exchange, option or purchase of a business; or
3. Lists or solicits prospective purchasers of a business.
APPLICATION: Complete and sign the business broker application.
FEE: The Business Broker Permit application fee is $40.00. Make checks payable to the Nevada Real
Estate Division. Cash in exact change and credit cards are accepted for in person counter transactions.
EXAM: Original exam results (for exam scheduling, contact Pearson VUE testing service:
http://www.pearsonvue.com/nv/realestate/, or call: (888) 248-8055).
EDUCATION: Attach proof of an approved 24-hour Nevada Business Brokerage course. Distance
learning courses as deemed equivalent by the division are accepted. A list of real estate schools that offer
this course is located on the NRED web site http://red.nv.gov/. See Form 502 for course information.
FINGERPRINTS: Attach verification of prints taken electronically by an approved vendor. The approved
vendor list is located on the NRED website, see Form 619.
FINGERPRINT BACKGROUND WAIVER: Complete the Nevada Department of Public Safety waiver
form attached to this application.
STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 * (702) 486-4033
e-mail: realest@red.nv.gov * http://red.nv.gov/
Revised 12/11/18 Page 2 of 5 Form 624
NEVADA BUSINESS BROKER PERMIT APPLICATION
*Only information deemed by law to be confidential shall be confidential (SSN, exam results, background investigation results). Most
information provided by an applicant for licensure is public information and must be provided upon request. By policy, the Real
Estate Division shall post (via the web site) and sell licensee lists which include w licensee’s name, business address (even if same as
home address), and business telephone number.
1. Name of Licensee:
License No.: ___________
Busb.: ___________
Home Address*:
No. & Street
City
State
Zip Code
Phone*:______________________________________ E-Mail address*:________________________________________
2. Business name:
Business Address:
No. & Street
City
State
Zip Code
*Signature of authorized broker or authorized broker-salesperson (in accordance to NAC 645):
X
X
#
Print name of Broker or Broker-salesperson
*Signature of Broker or Broker-salesperson
Broker or Broker-sales license number
3.
CRIMINAL AND OTHER BACKGROUND HISTORY: If your answer is YES, attach the order of the court or agency
which was rendered as a result of the proceedings. Give full details, including the administrative agency, court, title of the
proceeding, disposition and any other pertinent information on an attached sheet. —OR—
Write “on file with the division” next to the area you identified with a “yes”, if this information was previously disclosed in
an application submitted previously with the Nevada Real Estate Division.
a.
Yes No
Have you or any business in which you are or were an owner, partner, officer or director ever been
involved in an administrative proceeding regarding any professional or occupational license?
b.
Yes No
Has any license issued to you or any partnership or corporation of which you were a member or
officer by any public authority been suspended or revoked?
c.
Yes No
Has a surety company declined to be surety on any bond written on you in the two years prior to the
date of the application?
d.
Yes No
Have you ever been convicted of a felony, gross misdemeanor, or misdemeanor?
e.
Yes No
Have you ever been convicted of, or are you under indictment for, or have you entered a plea of guilty
or nolo contendere to forgery, embezzlement, obtaining money under false pretenses, larceny,
extortion, conspiracy to defraud or any crime involving moral turpitude?
f.
Yes No
Are you presently on parole or probation or paying any restitution?
g.
Yes No
Have you ever filed bankruptcy or has bankruptcy been filed against you? If filed within 7 years from
the date of this application, please provide a copy of the discharge. Date of discharge_________.
STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 * (702) 486-4033
e-mail: realest@red.nv.gov * http://red.nv.gov/
Revised 12/11/18 Page 3 of 5 Form 624
4. CHILD SUPPORT: PURSUANT TO NRS 645.358, THE FOLLOWING STATEMENT MUST BE ANSWERED AND
SIGNED. YOUR APPLICATION FOR THE ISSUANCE OF THIS LICENSE WILL BE DENIED IF YOU DO NOT
INDICATE ON THE STATEMENT WHICH OF THE PROVISIONS THAT APPLIES TO YOU.
I am NOT subject to a court order for the support of a child.
I am subject to a court order for the support of one or more children and AM IN COMPLIANCE with that order or
plan approved by the district attorney or other public agency enforcing the order for the repayment of the amount
owed in that order.
I am subject to a court order for the support of one or more children and NOT IN COMPLIANCE with that order or
plan approved by the district attorney or other public agency enforcing the order for the repayment of the amount
owed in that order.
5. Declaration: NRS 53.045
I hereby state under penalty of perjury that the answers contained in this application are true and correct; and
I understand that if I am subject to a court order for support of one or more children and I am not in compliance with that order or plan,
my application for license, certification or renewal of a license or certification will be denied.
I further certify that I will faithfully comply with all the statutes and regulations of the State of Nevada pertaining to the conduct of a
Business Broker in the State of Nevada.
I, by signing this application, authorize any person or institution to which reference is made by me in connection with the application to
release or divulge to the Real Estate Division any information in the possession of such person or institution regarding me.
_______________________________________________
Print name
______________________________________________
Applicant Signature
_________
date
STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 * (702) 486-4033
e-mail: realest@red.nv.gov * http://red.nv.gov/
Revised 12/11/18 Page 4 of 5 Form 624
REPORT OF EXISTENCE OF NEVADA BUSINESS LICENSE
Pursuant to NRS 645
All applicants MUST complete this section. Please select ONE option.
I have a Nevada business license number assigned by the Nevada Secretary of State upon compliance with
the provisions of NRS Chapter 76.
My Nevada business license number is: _______________________________________
I have applied for a Nevada business license with the Nevada Secretary of State upon compliance with the
provision of NRS Chapter 76 and my application is pending.
I do NOT have a Nevada business license number.
The Real Estate Division is not the arbiter of determining whether the applicant needs a business license.
Information about the Nevada business license can be found on the Secretary of State’s website at:
http://nvsos.gov/
STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 * (702) 486-4033
e-mail: realest@red.nv.gov * http://red.nv.gov/
Revised 12/11/18 Page 5 of 5 Form 624
CONSENT TO SERVICE OF PROCESS FORM
(THIS FORM REQUIRED FOR NON-NEVADA RESIDENTS ONLY)
Last
First
M.I.
Hereinafter referred to as “Applicant,” hereby irrevocably constitutes and appoints the Administrator of the
Division of Real Estate, Department of Business & Industry, State of Nevada or his/her successor in office, to
be his/her true and lawful attorney within this state, upon whom all legal process in any suit, action or
proceeding arising under, or in any way connected with any provisions of Chapter 645, 645C, 119, 119A,
119B of Nevada Revised Statutes, or any rule or order pursuant thereto, or based upon any fraud, deceit,
breach or contract or other thing connected with the sale or offer for sale, negotiation or appraisal of any real
estate, timeshare or campground membership, may be served upon said applicant, personally within the State
of Nevada. Until the applicant attests by affidavit to the Administrator that he/she is a bona fide resident of
the State of Nevada, this appointment and the authority of said attorney shall continue in force and effect so
long as any such liability remains outstanding, and a copy of any process served hereunder may be sent by
certified mail, return receipt requested, addressed to:
Street Address
City
State
Zip Code
Drivers License Number
State
State of
ss. County of
This instrument was acknowledged before me on (date) _________________________, in the possession of the
applicant.
(name of person who presents the document)
(Signature of person who presents the document)
Date
Signature of Notarial Officer
My Commission Expires:
(Seal)
0505RCCD-003(07/2017rev)
Fingerprint Background Waiver Page 1 of 2
Fingerprint Background Waiver
As an applicant who is the subject of a Federal Bureau of Investigation (FBI) fingerprint-based
criminal history record check for a noncriminal justice purpose you have certain rights which are
discussed below.
1. You must be notified by the Nevada Real Estate Division (name of requesting agency)
that your fingerprints will be used to check the criminal history records of the FBI and the
State of Nevada.
2. If you have a criminal history record, the officials making a determination of your suitability
for the job, license or other benefit for which you are applying must provide you the
opportunity to complete or challenge the accuracy of the information in the record. You may
review and challenge the accuracy of any and all criminal history records which are returned
to the submitting agency. The proper forms and procedures will be furnished to you by the
Nevada Department of Public Safety, Records Bureau upon request. If you decide to challenge
the accuracy or completeness of you FBI criminal history record, Title 28 of the Code of
Federal Regulations Section 16.34 provides for the proper procedure to do so:
16.34 - Procedure to obtain change, correction or updating of identification
records. If, after reviewing his/her identification record, the subject thereof
believes that it is incorrect or incomplete in any respect and wishes changes,
corrections or updating of the alleged deficiency, he/she should make application
directly to the agency which contributed the questioned information. The subject of
a record may also direct his/her challenge as to the accuracy or completeness of any
entry on his/her record to the FBI, Criminal Justice Information Services (CJIS)
Division ATTN: SCU, Mod. D-2, 1000 Custer Hollow Road, Clarksburg, WV 26306.
The FBI will then forward the challenge to the agency which submitted the data
requesting that agency to verify or correct the challenged entry. Upon the receipt of
an official communication directly from the agency which contributed the original
information, the FBI CJIS Division will make any changes necessary in accordance
with the information supplied by that agency.
3. Based on 28 CFR § 50.12 (b), officials making such determinations should not deny the
license or employment based on information in the record until the applicant has been
afforded a reasonable time to correct or complete the record or has declined to do so.
4. You have the right to expect that officials receiving the results of the fingerprint-based
criminal history record check will use it only for authorized purposes and will not retain or
disseminate it in violation of federal or state statute, regulation or executive order, or rule,
procedure or standard established by the National Crime Prevention and Privacy Compact
Council.
0505RCCD-003(07/2017rev)
Fingerprint Background Waiver Page 2 of 2
5. I hereby authorize the Nevada Real Estate Division (name of requesting agency)
(name of requesting agency), to submit a set of my fingerprints to the Nevada Department
Public Safety, Records Bureau for the purpose of accessing and reviewing State of Nevada
and FBI criminal history records that may pertain to me.
In giving this authorization, I expressly understand that the records may include information
pertaining to notations of arrest, detainments, indictments, information or other charges for
which the final court disposition is pending or is unknown to the above referenced agency.
For records containing final court disposition information, I understand that the release may
include information pertaining to dismissals, acquittals, convictions, sentences, correctional
supervision information and information concerning the status of my parole or probation
when applicable.
6. I hereby release from liability and promise to hold harmless under any and all causes of legal
action, the State of Nevada, its officer(s), agent(s) and/or employee(s) who conducted my
criminal history records search and provided information to the submitting agency for any
statement(s), omission(s), or infringement(s) upon my current legal rights. I further release
and promise to hold harmless and covenant not to sue any persons, firms, institutions or
agencies providing such information to the State of Nevada on the basis of their disclosures. I
have signed this release voluntarily and of my own free will.
A reproduction of this authorization for release of information by photocopy, facsimile or similar
process, shall for all purposes be as valid as the original.
In consideration for processing my application I, the undersigned, whose name and signature
voluntarily appears below; do hereby and irrevocably agree to the above.
Applicant’s Name:
PLEASE PRINT
Last Name
First Name
Middle
ADDRESS:
PLEASE PRINT
Applicant’s Signature:
Date:
Submitting Agency:
Nevada Real Estate Division
Address:
3300 West Sahara Avenue #350
Las Vegas, NV 89102
Agency Representative:
PLEASE PRINT
Last Name
First Name
Middle
Agency Representative Signature:
Date:
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Completed 28 December 2021

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