DOUGLAS A. DUCEY
GOVERNOR
JUDY LOWE
COMMISSIONER
form COM-105 rev 6-11-2018
Arizona Department of Real Estate (ADRE)
Enforcement & Compliance Division
www.azre.gov
100 North 15
th
Avenue, Suite 201, Phoenix, Arizona 85007
COMPLIANCE AFFIDAVIT
(Respondent Signature Only) (COM-105)
License Name: _____________________________ License #___________________
Print Name of Respondent
Consent Order Number: __________________ Consent Order dated _____________________
i.e. =yearF-DI-000 Commissioner’s Signature Date
I,_____________________________, hereby affirm that since the entering of the above Consent Order:
_______ I have complied with all of the terms and conditions set forth in the above Consent Order.
initials
_______ I have not violated any provision of the Title 32, Chapter 20 of the Arizona Revised Statutes.
Initials
_______I have not violated any provision of the Title 4, Chapter 28 of the Arizona Administrative Code (Commissioner’s Rules).
initials
I declare under the penalty of perjury that the above statements are true. I agree to maintain the original signed Affidavit for
5 years.
Respo
ndent’s Signature Date
*For more information or questions visit www.azre.gov
