Fill - CHECKLIST AND APPLICATION FOR REINSTATEMENT TIMESHARE LICENSE (Nevada Real Estate Division)

STATE OF NEVADA

DEPARTMENT OF BUSINESS AND INDUSTRY

REAL ESTATE DIVISION

3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 * (702) 486-4033

realest@red.nv.gov * http://red.nv.gov/

Revised 2/6/2019 Page 1 of 5 Form 511

TIMESHARE LICENSE

CHECKLIST AND APPLICATION FOR REINSTATEMENT

IMPORTANT: For failure to renew a timeshare license before it has expired, a sales agent must file an

application for reinstatement, submit current fingerprint cards or be finger printed, and pay the

required fee. (NAC 119A.120)

APPLICATION and FEES: Residents and non-residents may apply with a completed reinstatement

form 511. Attach the documents listed below and the fee(s) as follows:

$200.00

–

Renewal Fee

$100.00

–

Late Renewal Penalty

$20.00

–

Reinstatement Fee, see next page

$25.00

–

Change of Employer or a Change of Brokerage Company Information

Add the $25.00 employer change fee only if your employing project broker (PB) has changed.

Please make checks payable to the Nevada Real Estate Division or NRED.

FINGERPRINTS: Attach verification of prints taken electronically by an approved vendor. The

approved vendor list is located on the NRED website, see Form 619.

EDUCATION: Provide a copy of the course certificate(s) for Timeshare Agent continuing education

requirement of 6 hours. Attach copies of certificates to the reinstatement application. Certificates must be

dated within 2 years from the reinstatement application submission date.

NON-US CITIZENS: Please provide proof of eligibility to work. Copies may be enlarged.

FINGERPRINT BACKGROUND WAIVER: Complete the Nevada Department of Public Safety

waiver form attached to the reinstatement 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

realest@red.nv.gov * http://red.nv.gov/

Revised 2/6/2019 Page 2 of 5 Form 511

APPLICATION FOR REINSTATEMENT

(Nevada Real Timeshare Agent License)

Fees:

$200.00

–

Renewal Fee

$100.00

–

Late Penalty Fee

$20.00

–

Fee for Reinstatement or Change from Inactive to Active Status

$25.00

–

Change of Employer or a Change of Brokerage Company Information

INSTRUCTIONS:

• Original signatures are required.

• Payment is accepted as credit card, check or money order payable to the Nevada Real Estate Division

(NRED) or cash in exact change.

1. Personal Information:

License Number:

Date:

Name of Licensee:

Last

First

Middle

Home Address:

No. & Street

City, ST

Zip Code

Phone Contact:

Email Address:

Mailing Address (If different from above):

Applicant Completes Section #1

Office Use Only:

Receipt #

Date:

Processor Initials:

FP Forwarded 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

realest@red.nv.gov * http://red.nv.gov/

Revised 2/6/2019 Page 3 of 5 Form 511

2. Company Affiliation:

Project Broker Name:

Project Name:

Project Address:

No. & Street

City, ST

Zip Code

Business Phone:

Developer Name:

I hereby certify that I am the project broker or authorized licensed office manager pursuant to NAC 645.178 registered

with the Real Estate Division of the Department of Business and Industry, State of Nevada. If a license is issued to the

applicant (print name of applicant) ___________________________________, I will exercise careful supervision over

his/her Timeshare sales activities while he/she is associated with or employed by me.

License Number:

Signature:

(Broker or Broker Salesman Office Manage completes section #2. Original signatures only.)

3. Criminal and Other Background History: If your answer is YES to any of the following questions, attach the

order as a result of the proceedings. On an attached sheet give full details, including the administrative agency, court,

and title of the proceeding, disposition and any other pertinent information. (see NRS 645.330)

Yes

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?

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?

Has an application for any type of license been denied?

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?

Have you ever been convicted of a felony, gross misdemeanor, or misdemeanor?

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?

Are you presently on parole or probation or paying any restitution?

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

realest@red.nv.gov * http://red.nv.gov/

Revised 2/6/2019 Page 4 of 5 Form 511

4. Child Support Statement: PURSUANT TO NRS 119A.263, 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. REPORT OF EXISTENCE OF NEVADA BUSINESS LICENSE:

Pursuant to NRS 353C.1965

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/

6. Applicant Declaration: I declare under penalty of perjury that the answers contained in this application are true

and correct. (NRS 53.045)

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 Timeshare licensees in accordance with the NRS/NAC 119A statutes and regulations.

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.

(Please Print)

Applicant Name

Applicant Signature

STATE OF NEVADA

DEPARTMENT OF BUSINESS AND INDUSTRY

REAL ESTATE DIVISION

3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 * (702) 486-4033

realest@red.nv.gov * http://red.nv.gov/

Revised 2/6/2019 Page 5 of 5 Form 511

OUT OF STATE APPLICANTS ONLY!

CONSENT TO SERVICE OF PROCESS

Only a non-Nevada Resident completes this form

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

Driver’s License Number:

State:

State of

ss.

County of

This instrument was acknowledged before me in the possession of

Print name of person presenting document

(Signature of person who presents the document)

Date

Signature of Notarial Officer

My Commission Expires:

ARE YOU A VETERAN?

Yes

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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