Fill - Complete in full. Read instructions on page 2 (California Department of Real Estate)

ADD/CANCEL FICTITIOUS BUSINESS NAME (DBA)

GENERAL INFORMATION

 Complete in full. Read instructions on page 2 before completing.

 Attach copy of led Fictitious Business Name Statement.

 The responsible Broker's or Corporation's principal place of business as listed on the Fictitious

Business Name Statement must match the responsible Broker's or Corporation's main oce address.



This form can be used for Salesperson or Broker Associate owned ctitious business names.

 Type or print clearly in blue or black ink.

 All signatures must be original signatures.













DRE RECEIVED DATE

8. PRINTED NAME OF SIGNING RESPONSIBLE BROKER OR BROKER-OFFICER

9. SIGNATURE OF RESPONSIBLE BROKER OR BROKER-OFFICER (MUST BE ORIGINAL OR ELECTRONIC* SIGNATURE)

10. DATE

PROCESSOR # DATE PROCESSED SENDER'S # DATE SENT

DRE

ONLY

3A. FICTITIOUS BUSINESS NAME (DBA) -- PRINT AS IT APPEARS ON FILING FROM COUNTY CLERK.

 ADD

 CANCEL

3B. FICTITIOUS BUSINESS NAME (DBA) -- PRINT AS IT APPEARS ON FILING FROM COUNTY CLERK.

 ADD

 CANCEL

3C. FICTITIOUS BUSINESS NAME (DBA) -- PRINT AS IT APPEARS ON FILING FROM COUNTY CLERK.

 ADD

 CANCEL



I hereby certify that I have read and am aware of the requirements set forth in Business and Professions Code Section(s) 10159.5 through Section 10159.7, and that a

written contract has been signed by me and my responsible broker permitting me to le an application on behalf of my responsible broker with a county clerk to obtain a

ctitious business name. Additionally, I understand that I may apply and pay for, obtain, and maintain ownership of a ctitious business name that may be used subject

to the control of my responsible broker. I further understand when I use a ctitious business name that meets these conditions, I must include my responsible broker’s

identity in marketing and solicitation materials, in a manner required by the Real Estate Law. Furthermore, I understand that any issues or disputes between myself and

the responsible broker or broker ocer, identied below, regarding the ownership and/or use of such ctitious business name is a civil matter and would not fall under

the purview of the Department of Real Estate.

4. PRINTED NAME OF SALESPERSON OR BROKER ASSOCIATE 5. DRE SALESPERSON OR BROKER ASSOCIATE LICENSE NUMBER

6. SIGNATURE OF SALESPERSON OR BROKER ASSOCIATE

(MUST BE ORIGINAL OR ELECTRONIC* SIGNATURE)

7. DATE

* Electronic signature must comply with California Uniform Transactions Act (CA Civ. Code section 1633.1 et.seq.)



I hereby certify that I have read and am aware of the requirements set forth in Business and Professions Code Section(s) 10159.5 through Section 10159.7, and that a

written contract has been signed by a salesperson operating under my supervision and myself allowing him or her to le an application with a county clerk to obtain

a ctitious business name on my behalf. Additionally, I understand that this salesperson may apply and pay for, obtain, and maintain ownership of a ctitious business

name that may be used subject to my control as the responsible broker. I further understand when allowing a salesperson to use a ctitious business name, that meets

the conditions set forth above, my identity must be displayed in marketing and solicitation materials, in a manner required by the Real Estate Law.

Furthermore, I understand that any issues or disputes between myself and the salesperson, identied above, regarding the ownership and/or use of such ctitious business

name is a civil matter and would not fall under the purview of the Department of Real Estate.

DRE USE ONLY

1. BROKER OR CORPORATION DRE LICENSE NUMBER 2. BROKER OR CORPORATION NAME - DO NOT LIST DBA or Fictitious Business Names

click to sign

signature

click to edit

click to sign

signature

click to edit

RE 247 — Page 2 of 3

INSTRUCTIONS

General Information

 







     



























 





        





 



 





 









 

         





      

        





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 

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



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 



















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        

 

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

 



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 





      

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       

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 



        

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        

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

       

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



 

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











          



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

       





 

 

 













  

         





  





         

        

          











        



          







          









         

        

       

       

       













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 



 

         



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





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