Fillable FORM MUST BE COMPLETED BY VERIFYING BROKER.: NRS (Nevada Real Estate Division)

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FORM MUST BE COMPLETED BY VERIFYING BROKER.: NRS (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 / realest@red.nv.gov / http://red.nv.gov/
Revised 12/11/2020 Page 1 of 1 509A
EXPERIENCE VERIFICATION FOR A NEVADA PROPERTY MANAGER
NRS 645.6055
FORM MUST BE COMPLETED BY VERIFYING BROKER.
1. Name of Permit holder: Permit Number:
State of issuance:
2. Employment History: Full-time Part-time
3. Employment Dates: From to
From to
From to
Month / Day / Year Month / Day / Year
Multiple lines may be used for breaks in employment with same broker and company only.
4. Broker Declaration:
This is to verify that I, , am/was the real estate broker for the company
named:
(check the boxes that apply)
I am/was the real estate property manager. Permit Number: PM.
I authorized , permit number PM. , as the designated
property manager located at:
Under penalty of perjury, I declare that the foregoing is true and correct.
Print Name: Signature of Broker:
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FORM MUST BE COMPLETED BY VERIFYING BROKER.: NRS (Nevada Real Estate Division)

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Completed 28 December 2021

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