Fillable CHECKLIST FOR TEMPORARY BROKER LICENSE FORM DO NOT (Arizona Department of Real Estate)

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CHECKLIST FOR TEMPORARY BROKER LICENSE FORM DO NOT (Arizona Department of Real Estate)

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Temporary Broker License Checklist Form LI-240/rev 8/19
CHECKLIST FOR TEMPORARY BROKER LICENSE FORM
DO NOT SUBMIT THIS APPLICATION BY FAX OR E-MAIL
To submit packet:
• Submit Temporary Broker License Form and $50 filing fee.
• Subm
it Disciplinary Actions Disclosure Form (LI-214/LI-244).
• If
you are an unlicensed individual, also complete and submit Licensee’s Personal Information Form (LI-235).
• Subm
it a letter advising the Department of the broker’s illness, disability, or death. If broker is deceased, you must
provide a copy of the death certificate, or newspaper obituary.
• Submit a letter from the surviving spouse, attorney representing the broker/family, personal representative, or other
responsible party appointing an individual to serve as a temporary broker.
• A s
alesperson or associate broker who is appointed as Temporary Broker must submit a severance from the prior
employing broker or be administratively severed.
• Whe
n issued, license is valid for up to 90 days except, under “B”, additional time may be granted not to exceed 15
months. Should additional time beyond 90 days be required, the temporary broker must submit a written request to
the Department at least two weeks prior to the expiration date of the temporary broker’s license.
NO MORE THAN ONE TEMPORARY BROKERS LICENSE WILL BE ISSUED
Pursuant to A.R.S. § 32-2133 and A.A.C. R4-28-305;
A. T
he Commissioner may issue a temporary license as a broker to a licensed or unlicensed person for the purpose of winding
up the existing or pending business of a licensed broker in the following cases:
1. To the
surviving spouse, next of kin, the administrator or personal representative, or an employee of the
administrator or personal representative of a deceased licensed broker.
2. To t
he spouse, next of kin, employee, legal guardian or conservator of a licensed broker disabled by sickness, injury
or insanity.
B. Each temporary license is for a period of not over 90 days and shall not be extended for a longer period, except that a
license issued to an administrator or personal representative or the employee of the administrator or personal
representative continues until the personal representative or administrator disposes of the deceased broker’s business, but
not to exceed a period of 15 months.
Sa
ve time—take a moment to review your application and make sure you have signed it where required and have attached
supporting documents and the required fee before you submit to the Department. If the Department receives an incomplete
application, we will return the application to you unprocessed.
“A
N EQUAL EMPLOYMENT OPPORTUNITY AGENCY”
Th
is form is available in alternate formats by contacting the Operations Office at 602-771-7760 or
by email at www.azre.gov
through the Message Center
Temporary Broker License Checklist Form LI-240/rev 8/19
You can do more than renew online! Go to www.azre.gov
Review checklist for instructions and fees before filing this form.
APPLICATION FOR TEMPORARY BROKER’S LICENSE
FORM
Temporary Broker’s Name:
_______________________________________________________________
License No., if applicable: __________________________________________
Expiration Date: ___________________
Type of License: Real Estate Cemetery Membership Camping
Check here if not licensed and attach Licensee’s Personal Information Form and Disciplinary Actions Disclosure Form
(LI-214/LI-244)
___________________________________________________ __________________________
Temporary Broker’s Signature Date
Present Designated Broker’s Name: _________________________________________________________________
Reason for this application: Illness (provide letter) Death: (provide copy of certificate, if available)
Employing Broker/Entity Legal Name: ______________________________________________________________
Entity License No.: ______________________________________ Expiration Date: __________________________
Business Address: ______________________________________________________________________________
Business Phone Number: ____________________________ Fax Number: _________________________________
“AN
EQUAL EMPLOYMENT OPPORTUNITY AGENCY”
This form is available in alternate formats by contacting the Operations Office at 602-771-7760 or
by email at www.azre.gov
through the Message Center
For Department Use Only
Eff
ective Date: _________________________
Date E
ntered: _________________________
90-Day Exp. Date: ______________________
Licens
e No.:___________________________
By: ______________ TF 1 TF 2
ARIZON
A DEP
ARTMEN
T
OF REAL
E
STATE (ADRE)
www.azre.gov
100 North 15th Avenue, Suite 201, Phoenix, Arizona 85007
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signature
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Notice to Applicant Pursuant to A.R.S. § 41-1030
An agency shall not base a licensing decision in whole or in part on a licensing requirement or condition that is not specifically
authorized by statute, rule or state tribal gaming compact. A general grant of authority in statute does not constitute a basis for
imposing a licensing requirement or condition unless a rule is made pursuant to that general grant of authority that specifically
authorizes the requirement or condition.
This section may be enforced in a private civil action and relief may be awarded against the State. The court may award
reasonable attorney fees, damages and all fees associated with the license application to a party that prevails in an action
against the state for a violation of this section.
A State employee may not intentionally or knowingly violate this section. A violation of this section is cause for disciplinary action
or dismissal pursuant to the Agency's adopted personnel policy.
This section does not abrogate the immunity provided by section 12-820.01 or 12-
820.02
Notice to Applicant Pursuant to A.R.S. § 41-1093.01
An agency shall lim
it all occupational regulations to regulations that are demonstrated to be necessary to specifically fulfill a
public health, safety or welfare concern. Pursuant to sections 41-1093.02 and 41-1093.03, Arizona Revised statutes, you have
the right to petition this agency to repeal or modify the occup
ational regulation or bring an action in a court of general jurisdiction
to challenge the occupational regulation and to ensure compliance with section 41-1093.01, Arizona Revised Statutes.
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CHECKLIST FOR TEMPORARY BROKER LICENSE FORM DO NOT (Arizona Department of Real Estate)

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Completed 20 July 2020

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