Fillable ENTITY/BROKER STATUS CHANGE (LI-216) (Arizona Department of Real Estate)

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ENTITY/BROKER STATUS CHANGE (LI-216) (Arizona Department of Real Estate)

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EN
TITY/EMPLOYING BROKER/BROKER STATUS CHANGE (LI-216) Rev. 04/2014
ENTITY/BROKER STATUS CHANGE (LI-216)
SELECT TYPE OF CHANGE(S)
Entity Legal Name/DB Name
DB Change For Existing Entity
DB Change to SE
Inactive Broker Change to Active DB
Associate Broker Change to DB for Existing Entity
Active DB Change to Inactive
Associate Broker Change to SE
New Broker Licensee to DB
Change Entity to Inactive
Resident Broker Change to Non-Resident Broker (out-of-state Principal Office Address)
SE to Inactive
SELECT BUSINESS TYPE
Corporation (CO)
Limited Liability Company (LC)
Partnership (PA)
Sole Proprietor (SE)
Limited Liability Partnership (PA)
Broker
Designated Broker (DB)
Salesperson
SECTION 1:DESIGNATED BROKER (DB)/SOLE PROPRIETOR (SE)/LICENSEE INFORMATION
DB/SE/Licensee Name (First MI Last)
DB/SE/Licensee License Expire Date
Email
Fax:
Questions
Responses
1. How is the Incoming Licensee currently licensed? (DB) (SE) (attach LI-201A) Associate Broker Salesperson
2. Is the Incoming DB/Sole Proprietor currently employed as “active status”? Yes No – go to question 6
3. Is the prior current/prior licensed entity closing? Yes – go to Question 5 No
4. Is the prior licensed entity appointing a new DB (if not closing)? Yes – go to Question 6 No
5. Does the prior licensed entity have “active” agents? Yes – refer to Instructions No
6. As the changing Broker, are continuing education (CE) requirements current?
ARS §32-2130
Yes No – STOP, Reapply when current
7. As the changing Broker, has a 9-hour Broker Management Clinic been
completed within 23 months prior to this application?
ARS §32-2136 (C)
Yes – Date ________________ No – STOP, Reapply when current
8. Is there a joint PC or PLLC with ADRE for the incoming DB’s name?
ARS §32-2125 (B)
Yes - STOP, Amend to single PC or
PLLC with the ACC and reapply
No
9. Does this DB have a PC or PLLC in good standing with the Arizona Corporation
Commission?
Yes No - STOP,
Reapply
Not
Applicable
10. Will this DB reside outside of the State of Arizona Yes – complete Non-Resident
Broker section below
No
SECTION 2: ENTITY/EMPLOYING BROKER INFORMATION
Legal Name (as approved by ADRE)
EIN (Employer Identification
Number) or Tax ID # (Required)
Doing Business as (DBA) – if any (as approved by ADRE)
Physical Address of Entity
Suite
City
State
Zip
Mailing Address of Entity:
Same as Physical Address
Suite
City
State
Zip
Email
Fax:
Entity License Number:
Entity Expiration Date (Aligned)
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 LO
WE
COMMISSIONER
ENTITY/EMPLOYING BROKER/BROKER STATUS CHANGE (LI-216) Rev. 04/2014
SECTION 3: SELECT BUSINESS TYPE OF CHANGE(S) BEING MADE
ENTITY LEGAL/DBA NAME
CHANGE
If CO or LLC amended articles stamped “FILED” by the Arizona Corporation Commission (ACC). Do not submit until
a stamped “FILED” copy is received.
If Partnership, copy of addendum/amendment to Partnership Agreement showing change.
ADRE Entity/Employing Broker Name Reservation Notice (ADRE Approval Notice)
DESIGNATED BROKER (DB)
CHANGE FOR EXISTING ENTITY
A copy of the resolution signed by all officers and directors electing/appointing a DB as a corporate officer, naming
the office held and stating that the individual was appointed to act as the DB for the corporation.
Amended Articles stamped “Filed” by the AZ Corporation Commission (ACC). If an LLC entity, the amendment
must name the DB as a member/manager of the LLC. Do not submit until a stamped “Filed” copy is received.
Letter of resignation of outgoing DB (attached).
Incoming DB severed on-line, if not a Branch Manager at prior company.
Copy of Salesperson/Associate Broker Change Form LI-202 signed by prior DB, if incoming DB was a Branch
Manager at prior company. (Attached)
Copy of Certificate of Broker Management Clinic taken within prior 23 months.
DESIGNATED BROKER (DB)
CHANGE TO
SOLE PROPRIETOR
(SE)
Letter of resignation as outgoing DB (attached).
Copy of Certificate of Broker Management Clinic taken within prior 23 months.
When current Entity closing, follow closing procedure with Auditing.
ADRE Approved Entity/Employing Broker Name Reservation Notice.
Sever licensees online, only when instructed by ADRE to do so.
INACTIVE BROKER CHANGE TO
ACTIVE DESIGNATED BROKER
(DB)
When becoming Designated Broker (DB) for an existing Entity, complete “Designated Broker (DB) Change For
Existing Entity” on Form LI-216.
Unlawful License Activity Statement Form LI-555.
ASSOCIATE BROKER CHANGE
TO DESIGNATED BROKER (DB)
FOR EXISTING ENTITY
Sever from current Broker.
When becoming Designated Broker for existing entity, complete the “Designated Broker Change For Existing
Entity” on Form LI-216.
ACTIVE DESIGNATED BROKER
(DB) CHANGE TO INACTIVE
Letter of resignation from current Entity.
Sever all licensees by using the Online Licensing System after notifying them of change. All Licensees may then
rehire Online from their personal page.
ASSOCIATE BROKER CHANGE
TO SOLE PROPRIETORSHIP (SE)
Sever online from prior entity.
When Branch Manager – “Salesperson/Associate Broker Change Form LI-202” signed by prior DB.
Copy of Certificate of Broker Management Clinic taken within prior 23 months.
When Inactive to Active – confirm continuing education (CE) is up-to-date.
NEW BROKER LICENSEE
CHANGE TO DESIGNATED
BROKER (DB) FOR EXISTING
ENTITY
All documents for Original Broker Application.
When becoming Designated Broker for existing entity, complete the “Designated Broker Change for Existing
Entity” on this Form LI-216.
CHANGE ENTITY TO INACTIVE
STATUS
Letter of Resignation of DB.
Procedure for closing office with Auditing completed.
Complete Form LI-216
RESIDENT BROKER CHANGE TO A NON-RESIDENT BROKER (Out-of-State Principal Office Address)
TRUST ACCOUNT INFORMATION –established with a Financial Institution located in Arizona AAC R4-28-302(A)
Check if using Arizona Based Title Company only
Trust Account Name
Trust Account Number
Financial Institution Name
Phone:
Fax:
Branch Address:
Street #
Suite
City
State
Zip
Additional account information attached.
ENTITY/EMPLOYING BROKER/BROKER STATUS CHANGE (LI-216) Rev. 04/2014
NON-RESIDENT EMPLOYING BROKER INFORMATION –
ARS §§32-2151.01(A); 32-2163 and R4-28-302(L)
A non-resident broker who maintains a principal office outside of Arizona shall:
Establish a trust account in Arizona
Maintain all records of transaction in Arizona –
Appoint a Custodian of Records
Custodian Name:
Address:
Email Phone: Fax:
A non-resident Employing Broker who employs any licensee(s) in the State of Arizona shall complete below:
Establish a branch office and appoint an Arizona licensed Branch Manager other than self.
Branch Office Information (of non-resident Employing Broker)
Legal Name
Phone:
Doing Business As (DBA) – if any
Fax:
Business Address:
Suite
City
State
Zip
Mailing Address: Same as above
Suite
City
State
Zip
Branch Manager (of non-resident Employing Broker)
Name (First MI Last):
License #:
License Expiration Date:
Email:
Phone:
Fax:
Describe the authority vested in the branch manager – ARS §32-2127 and AAC R4-28-304
Describe how the licensed employee(s) will be supervised – R4-28-302(L) & AAC R4-28-1103
I, __________________________________________________________________ acknowledge that I have read and understand the responsibilities set forth above.
Branch Manager Name
Branch Manager Signature _____________________________________________________________ Date _____________________________________________
FOR ADRE USE ONLY
Effective Date
Date Stamp
Receipt
Input Date
Time Frames
TF 1
TF 2
Processed By
Print Designated Broker/ Broker/ SE Licensee Name_______________________________________________________________________________
Designated Broker/ Broker/ SE/ Licensee Signature_________________________________________ Date___________________________________
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ENTITYBROKER STATUS CHANGE (LI-216) (Arizona Department of Real Estate)

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Completed 20 July 2020

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