Fillable COMMUNITY MANAGER CHANGE FORM FOR A COMMUNITY MANAGER (Nevada Real Estate Division)

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COMMUNITY MANAGER CHANGE FORM FOR A COMMUNITY MANAGER (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 03/20/2017 1 of 2 616
CHANGE FORM FOR A COMMUNITY MANAGER OR A SUPERVISING
COMMUNITY MANAGER
INSTRUCTIONS:
The Division must receive the original certificate and pocket card.
Complete only the areas that are specific to this transaction and a fee of $20.00 per section per certificate are required.
Payments are accepted in the form of check, cashier’s check, money order (made payable to NRED) or exact cash.
All applicants are required to answer and sign section 4.
Incomplete paperwork will not be processed and will be returned to you for completion.
Certificate number:
Date:
Name: (Please print)
First Middle Last (Suffix-if applicable)
Home address:
Phone:
1. $20
CHANGE OF COMPANY NAME OR ADDRESS: (Supervising Community Managers are required to attach a list of all
Provisional Community Managers and their original certificates and apply the $20 fee to each certificate.)
Company Name:
New Address:
Number, street, City, State, Postal Code
Mailing address (if applicable):
Business phone:
Email:
2. $20
STATUS CHANGE: CHECK ONE BOX.
a.
Provisional Community Manager to Community Manager.
b.
Community Manager to Supervising Community Manager. (Include form 617)
3. $20
PERSONAL NAME CHANGE: List the name on your current certificate at the top and list your new name here. Proof is required in
the form of a Divorce decree, Marriage Certificate, or a Judgment issued by the court.
New Name:
4. SIGNATURE:
Have you had any disciplinary sanctions imposed by any regulatory agency or commission within the past 5 years?
NO YES (If Yes, attach a written explanation and the final disposition.)
SIGNATURE of Community Manager, or Supervising Community Manager
X___________________________________________.
Division only: Date: __________________ Receipt: ___________________________ Initials: __________________________
Revised 03/20/2017 2 of 2 616
REPORT OF EXISTENCE OF NEVADA BUSINESS LICENSE
Pursuant to NRS 116A.435
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/
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COMMUNITY MANAGER CHANGE FORM FOR A COMMUNITY MANAGER (Nevada Real Estate Division)

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Completed 28 December 2021

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