ENTITY NAME ADDRESS CHANGE (LI-201) Rev. 04/2012
ENTITY ADDRESS CHANGE FORM (LI-201)
Ch
anges can be made online (No Fee) from the Designated Broker personal page. Log into
www.azre.gov, under Quick links, select
Business Address Change and follow the prompts.
Des
ignated Broker (DB)/ Sole Proprietor (SE) Name DB/SE Email Address
DB/SE License Number DB/SE License Expiration Date
SELECT BUSINESS TYPE OF CHANGE(S)
BUSINESS ADDRESS CHANGE BUSINESS MAILING ADDRESS CHANGE BUSINESS PHONE OR FAX NUMBER CHANGE (NO FEE)
SELECT CURRENT BUSINESS TYPE
CORPORATION (CO) LIMITED LIABILITY COMPANY (LC) PARTNERSHIP SOLE PROPRIETOR (SE) LIMITED LIABILITY PARTNERSHIP
NEW ADDRESS OR NEW INFORMATION
ENTITY LEGAL NAME (Or your name if Sole Proprietor)
DBA NAME (IF ONE IS USED)
NEW PHYSICALBUSINESS ADDRESS
SUITE OR UNIT
CITY, STATE, & ZIP CODE
MAILING ADDRESS or Same as Physical Business Address
SUITE OR UNIT #
CITY, STATE, & ZIP CODE
BUSINESS TEL#:
BUSINESS FAX#:
PRINT DESIGNATED BROKER NAME
SIGNATURE REQUIRED
X
DATE
(If Sole Proprietor, in signing this form, I declare I am the ONLY person who owns, has exclusive title or legal right to the business.)
Effective Date Date Stamp Receipt
Input Date
Processed By
ARIZONA DEPARTMENT OF REAL ESTATE (ADRE) Licensing
Division
www.azre.gov
100 North 15th Avenue, Suite 201, Phoenix, Arizona 85007
DOUGLAS A. DUCEY
GOVERNOR
JUDY
LOWE
COMMISSIONER
