Fill - Free fillable FORM RF-107: REAL ESTATE RECOVERY FUND APPLICATION FOR (Arizona Department of Real Estate) PDF form

RF-107 Rev. 03/02/2018 1

ARIZONA DEPARTMENT OF REAL ESTATE FOR DEPARTMENT USE ONLY

100 N. 15th Ave., Suite 201

Phoenix, AZ 85007

602-771-7760

www.azre.gov

APPLICATION FOR PAYMENT FROM THE

REAL ESTATE RECOVERY FUND

A.R.S. § 32-2186 et seq. RF File No.

FORM RF-107

GENERAL INFORMATION

A copy of Form RF-109 (Notice to Judgment Debtor) and a copy of this Application must be served on the judgment

debtor(s). A.R.S. §32-2188.01. This Application and all supporting information and documentation must be filed

with the Department of Real Estate within two years after the termination of all proceedings, reviews and appeals

connected with the judgment. The Commissioner may waive the two-year deadline if, in the Commissioner’s sole

discretion, the public interest would be served. A.R.S. § 32-2188(C). Consideration of your Application will be

delayed if the Application is incomplete. A.R.S. § 32-2188.02. To expedite handling, send this Application and all

supporting documents by certified mail to:

Arizona Department of Real Estate

Recovery Fund Administrator

100 N. 15th Ave., Suite 201

Phoenix, AZ 85004

• In this application, real estate, and cemetery salespersons and brokers are referred to as “agents.”

• A “judgment debtor” is any person or entity against whom the claimant has a judgment for money damages.

• “You” is all claimant individuals and entities. If the responses are different for any claimant, those questions must

be answered and explained separately for each claimant.

• Submission of all of the following information is required. Attach extra paper if more space is needed.

PART I—REQUIRED INFORMATION

1. CLAIMANT INFORMATION

Claimant Name(s) _____________________________________________________ Telephone No. _________________

Street Address ________________________________________________________ Fax No. ______________________

Email __________________________________________ City _______________________State, ZIP _______________

Complete the following additional information only if represented by an attorney in this Application:

Attorney’s Name/Law Firm ____________________________________________ Telephone No. __________________

Street Address ________________________________________________________ Fax No. ______________________

Email___________________________________________ City_____________________ State, ZIP ________________

Notify the Department promptly of any change in address or other contact information.

2. IDENTIFICATION OF ALL PARTIES IN THE LAWSUIT

A. List the name(s) and all addresses and phone numbers of judgment debtor(s), defendants in a Criminal Restitution

Order (CRO), and all of their attorneys. Include the address used for service of process and all addresses which can be

used for contact. If any address is unknown, provide the names and address of any person(s) who may have that

information. Mark the box with a check for any judgment debtor who is an agent. (Continued on Page 2)

RF-107 Rev. 03/02/2018 2

2. IDENTIFICATION OF ALL PARTIES IN THE LAWSUIT (Continued)

Agent Names (Last, First, Middle) Address (If different street/mailing addresses, include both) Telephone Numbers

______________________ _______________________________________________ _______________

B. If any party responsible for your losses was a salesperson or broker employed by another broker, did you sue their

employer? A.R.S. § 32-2188(E)(7) .......................................................................................................................... Yes No

If not, list here the parties you did not sue, and please explain:

________________________________________________________________________________________________________

C. If there are any parties other than a defendant who is the subject of a CRO who are potentially liable for your losses, did

you include all those parties in your civil lawsuit? ...................................................................................................... Yes No

If not, list here the parties you did not include, and please explain: ______________________________________________

________________________________________________________________________________________________________

D. Has any other party liable or potentially liable for your losses been dismissed or omitted from the civil lawsuit?

Yes No

If yes, list each party and explain the reason for dismissal or omission A.R.S. § 32-2188(E)(6) and (7) _______________

_______________________________________________________________________________________________________

________________________________________________________________________________________________________

3. THE REAL ESTATE TRANSACTION

A. What was the responsibility of each agent in the transaction? A.R.S. § 32-2186(A)(1) and (2).

EXAMPLES: John Doe - Seller, Dick Smith - Buyer, Jane Jones - Landlord, Sally Brown - Agent for Seller

________________________________________________________________________________________________________

B. What improper actions by any agent who is a judgment debtor were the reasons for your lawsuit? A.R.S. § 32-

2186(A)(1). If the agent was a principal in the transaction (the buyer, seller, landlord or tenant), include any

misrepresentations or fraud that occurred. A.R.S. § 32-2186(A)(2).

________________________________________________________________________________________________________

C. In a chronological narrative, describe all related facts that are the basis for the judgment or CRO. Include dates, dollar

amounts, participants, witnesses, description and address of the property involved, and important statements by anyone.

Attach an additional sheet if more space is required. A.R.S. § 32-2188(E)(4). (If more space is needed please attach

documents).

________________________________________________________________________________________________________

RF-107 Rev. 03/02/2018 3

4. JUDGMENT OR CRIMINAL RESTITUTION ORDER (CRO) ON WHICH THIS APPLICATION IS

BASED

If there is more than one judgment or CRO, complete this section for each judgment or CRO on a separate sheet.

A. Civil Judgment Criminal Restitution Order

B. Date issued: _________________________ Court and Court Case No. __________________________________

EXAMPLE: Maricopa County Superior Court, No. CV2002-01234

C. County Recorder’s Office Information A.R.S. § 32-2188(E)(8)(e):

Recording Date County & State Docket or Other ID No.

_________________________________ ______________________________________ ______________________________

D. Damages Awarded in the Judgment or CRO

Amount Describe the Source of Each Item EXAMPLES: Security Deposit, Down Payment, Rent, Repairs

1. $ _________ _______________________________________________________________________________

2. $ _________ ________________________________________________________________________________

3. $ _________ _______________________________________________________________________________

4. $ ________ ________________________________________________________________________________

5. $ ________ ________________________________________________________________________________

6. $ ________________ Attorney’s fees, if any

7. $ ________________ Court-awarded costs

8. $ ______________ Interest at _____ %. Explain below from what date and on what amounts you calculated

interest.(NOTE: Only prejudgment interest is recoverable from the Fund.)

9. $ ________________ Punitive damages, (NOTE: Punitive damages are not recoverable from the Fund.)

$ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ TOTAL JUDGMENT

Explain interest computations here:

__________________________________________________________________________________

E. Collection of Judgment:

NOTE: By law, you must exhaust all collection efforts against all parties before filing this Application. A.R.S.

§ 32-2188(E).

1) Have you exhausted all collections efforts against all judgment debtors? .............................................. Yes No

2) Have you diligently pursued collection efforts against all other persons liable to you in the transaction that is the

basis for the judgment or CRO?..................................................................................................................... Yes No

If your answer to 1 or 2 is No, please explain below:

3) List all attempts to collect the judgment from all judgment debtors. Include amounts recovered from

garnishments, attachments, executions and sale of debtors’property.

_____________________________________________________________________________________________

________________________________________________________________________________________________________

RF-107 Rev. 03/02/2018 4

5. CLAIM AGAINST RECOVERY FUND

NOTE: By law, only a claimant’s “actual and direct loss,” reasonable attorney’s fees, prejudgment interest (at the

legal rate from the date of loss) and court costs, are payable from the Recovery Fund. Therefore, the amount

covered by the Fund may differ from the amounts awarded in the Judgment. “Actual and direct loss” includes out-

of-pocket losses and excludes loss of anticipated profits, speculative and punitive damages. See A.R.S. § 32-2186(G)

for a more detailed list of losses that are not recoverable from the Fund.

A. Amount of claim against the Arizona Real Estate Recovery Fund: $_______________________________

B. Itemize each amount claimed and how it was computed:

EXAMPLE: $1,500 misappropriated rent for 123 S. State Street - rent collected by agent for June - August 1999 @

$500/month

_____________________________________________________________________________________________

C. Itemize any amount being claimed above and beyond the actual and direct out-of-pocket losses, prejudgment

interest, attorney’s fees and court costs. If you claim any amount that is not normally recoverable from the Fund,

explain why you believe it is recoverable in this case. Refer to applicable statutes and case law that support this

position:

____________________________________________________________________________________

D. Offsets and Deductions From the Claimed Amount:

List any amounts recovered or anticipated from any judgment debtors or other source, including settlements, bonding

or insurance companies and tax benefits taken or anticipated on state and federal income tax returns. If tax benefit/

loss was not claimed or is not anticipated, please explain. A.R.S. § 32-2188(E)(8)(h).

____________________________________________________________________________________

6. ADDITIONAL INFORMATION

Answer the following questions and provide the following information:

A. Have you ever been licensed as a real estate or cemetery salesperson or broker? A.R.S. § 32-2186(D)……………

Yes No

If yes, please state:

State(s) where licensed:

________________________________________________________________________________________________________

Name:

________________________________________________________________________________________________________

RF-107 Rev. 03/02/2018 5

6. ADDITIONAL INFORMATION (Continued)

Dates licensed: ________________________________________________________________________________

Type of license(s) EXAMPLES: Salesperson, self-employed broker, designated broker for an entity, etc.

________________________________________________________________________________________________________

B. Has your spouse, or an officer, director, owner, stockholder, partner or owner of 10 percent interest in any

claimant ever held a real estate or cemetery salesperson’s or broker’s license? ...................................... .Yes No

If yes, please state for each such person:

State(s) where licensed:

________________________________________________________________________________________________________

Dates licensed:

__________________________________________________________________________________________________

Type of license(s)

______________________________________________________________________________________________

C. Are you a spouse of the judgment debtor or a personal representative of the spouse? A.R.S. § 32-2188(E)(8)(a)………..

Yes No

D. Have you assigned or transferred all or any part of your interest in the judgment or CRO? ........................... Yes No

E. Have you signed a partial or full satisfaction of the judgment or CRO? A.R.S. § 32-2192(C) ....................... Yes No

If yes, please state the terms, dates and amounts satisfied or paid: ________________________________________________

________________________________________________________________________________________________________

F. Was the civil lawsuit on which the judgment is based prosecuted conscientiously and in good faith?

NOTE: “Conscientiously and in good faith” means that no party potentially liable to you in the underlying

transaction was intentionally and without good cause omitted from the complaint, that no party named in the

complaint who otherwise reasonably appeared capable of responding in damages was dismissed from the complaint

intentionally and without good cause, and that you employed no other procedural tactics contrary to the diligent

prosecution of the complaint in order to provide access to the Recovery Fund. A.R.S. §32-2188(E)(8)........ Yes No

G. Are you aware of anyone else who incurred monetary losses or damages in a real estate or cemetery transaction

due to the actions of any agent who is a judgment debtor? ......................................................................... Yes No

If so, who?

____________________________________________________________________________________________

H. Was this Application mailed or delivered to the Department within two years after the judgment became final or

the CRO was issued?..................................................................................................................................... Yes No

If Yes, please state the date the Application was mailed to the Department: ______________________________

If No, are you requesting a waiver? .............................................................................................................. Yes No

If you are requesting a waiver, please explain why you think you are entitled to a waiver. A.R.S. § 32-2188(C)

7. BANKRUPTCY BY PERSONS LIABLE FOR YOUR LOSSES

A. Do you have any knowledge or information that any judgment debtor has filed or intends to file for bankruptcy

protection?.................................................................................................................................................... Yes No

If no, skip to Section 7-B. If yes, please answer the following:

1) What is the complete bankruptcy case number?

_________________________________________________________________________________________

2) Did you receive a Notice to Creditors ...................................................................................................... Yes No

3) Is your judgment based upon a determination of nondischargeability in a bankruptcy proceeding filed by the

judgment debtor?.. LYes L No If yes, skip to Section 7-B. If no, please answer the following:

a. Did the judgment debtor file for bankruptcy protection? ....................................................................................... Yes No

RF-107 Rev. 03/02/2018 6

7. BANKRUPTCY BY PERSONS LIABLE FOR YOUR LOSSES (Continued)

If no, skip to Section 7-B. If yes, when did the judgment debtor file for bankruptcy protection?

_____________________________________________________________________________________________

b. Did you file a claim in the bankruptcy? .................................................................................................... Yes No

If not, please explain why not: ____________________________________________________________________

_____________________________________________________________________________________________

c. Was any attempt made to have the debt owed to you determined nondischargeable?............................... Yes No

If no, please explain why not. If yes, what was the result?

_____________________________________________________________________________________________

d. Was the debt underlying the judgment, and/or the judgment, discharged in the bankruptcy proceeding?..................

Yes No

If no, explain why. If yes, give the date it was discharged and state why:

–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––

_____________________________________________________________________________________________

B. Do you have any knowledge or information that any other person or persons liable to you in the transaction filed

or intends to file bankruptcy? .................................................................................................... Yes No

If no, skip to Box 8. If yes, please answer the following:

1) What is the name of the person or persons?

_____________________________________________________________________________________________

2) On what date did the person file bankruptcy?

_____________________________________________________________________________________________

3) Did you file a claim in the bankruptcy? ........................................................................................ Yes No

If no, please explain why not. _____________________________________________________________________

4) Was any attempt made to have the debt owed to you determined nondischargeable? ……………….. Yes No

If not, please explain why not. If yes, what was the result? _________________________________________________

_______________________________________________________________________________________________________

________________________________________________________________________________________________________

PART II—DOCUMENTATION

I HAVE ATTACHED THE FOLLOWING DOCUMENTATION:

As to each document/group of documents you attach, identify them with a cover sheet that has the number assigned

below and lists or describes each document.

EXAMPLE: Part II,Item 1:Purchase contract dated 3/2/01;Addendums to purchase contract dated 3/5/01 and 5/4/01;

Escrow instructions dated 5/31/02; Settlement statement, warranty deed, deed of trust and promissory note, all dated

5/31/02.

1. Purchase contract, escrow instructions, settlement statements, property management agreement(s), leases, checks,

other documents pertinent to the transaction ............................................................................................. Yes No

2. Letters, memos, faxes, emails, checks, invoices, ledgers, accountings, bank statements and other writings to prove

your out-of-pocket losses that resulted from the real estate transaction .................................................... Yes No

3. Original civil complaint and the amended version of those documents upon which the civil judgment is based,

including answers, third-party complaints and motions for summary judgment .......................................... Yes No

4. Original criminal information, complaint and/or indictment and the amended versions of those documents

explaining the basis for the judgment or CRO................................................................................................ Yes No

5. All orders dismissing any party from the civil lawsuit or criminal case, together with the motions, stipulations,

minute entries and other court documents upon which the dismissal is based .............................................. Yes No

RF-107 Rev. 03/02/2018 7

6. All minute entry orders, statements of decision or other statements by a judge or jury on determination of guilt

and/or monetary awards in the criminal or civil case .............................................................................. Yes No

7. All criminal conviction documents, including plea agreements, sentencing documents, jury or court verdicts, etc.

..................................................................................................................................................................... Yes No

8. All CROs and civil judgments entered. (Must be certified copies issued by the court bearing the court’s filing

stamp and county recorder’s office information. If it is an amended judgment, only the last amended version must be

certified and recorded .................................................................................................................................. Yes No

9. All notices of appeal, appellate court decisions, court orders on mandate, etc. ..................................... Yes No

10. Abstracts of judgment bearing evidence of having been recorded in the county or counties in which the judgment

debtor may possibly reside or have assets.................................................................................................... Yes No

Documentation (Continued)

11.Documentation of collection efforts conducted by me or on my behalf, including searches and inquiries with

respect to the assets of the judgment debtor(s) liable to be sold or applied to satisfaction of the judgment, an itemized

valuation of any assets discovered including a description of the results of my actions to have the assets applied to

satisfaction of the judgment (include judgment debtor exams and other examinations under oath, writs of execution,

attachment and garnishment, and all returns thereon) ……………………………………………………... Yes No

12. Bankruptcy filings including notice to creditors and orders of discharge or dismissal in any bankruptcy for

judgment debtor or any other liable party, together with any orders and their associated applications, motions or

stipulations, which relate specifically to the debt owed to me ....................................................................... Yes No

13. All settlement agreements, insurance claim awards, tax returns or tax benefit calculations, or other documents

concerning tax benefits or payment of a portion of the losses from the transaction....................................... Yes No

14. Notice of your Application as served on the judgment debtor (Form RF-109) ....................................... Yes No

15. Proof of service of the Notice and Application to the judgment debtor(s). Forms RF-110, 111 and 112 Yes No

16. Itemized affidavit of attorney’s fees and statement of court costs ........................................................... Yes No

LIST ADDITIONAL DOCUMENTATION HERE:

17.

_____________________________________________________________________________________________

18.

_____________________________________________________________________________________________

19.

_____________________________________________________________________________________________

20.

_____________________________________________________________________________________________

21.

_____________________________________________________________________________________________

22.

_____________________________________________________________________________________________

23.

_____________________________________________________________________________________________

24.

_____________________________________________________________________________________________

PART III—APPLICANT’S CONTINUING RESPONSIBILITIES

While this Application is pending, I expressly agree to: CLAIMANT’S INITIALS

1. Notify the Recovery Fund Administrator in writing of any information of which he or she becomes aware that any

judgment debtor has filed for bankruptcy protection.

2. Notify the Recovery Fund Administrator in writing of any assignment of the judgment to a third party.

3. Notify the Recovery Fund Administrator in writing if I receive or anticipate receiving any amounts

from any source in reimbursement or payment of the losses or the judgment, including insurance

proceeds and tax benefits either accrued or claimed.

4. Provide all additional information required by this Application as it becomes available.

RF-107 Rev. 03/02/2018 8

PART IV—SIGNATURE AND VERIFICATION

1. VERIFICATION BY CLAIMANT (Claimant must sign this verification even if represented by an attorney.)

STATE OF _________________________________

} ss

COUNTY OF ________________________________

I am the Claimant in this Application. I declare under penalty of perjury that all parts of the Application are

true and correct. I have read the Application and all attachments and know the contents, and I certify that they are

true of my own knowledge, except as to those matters that are stated upon my information or belief, and as to those

matters I believe them to be true. I further certify that all documents attached to the Application are true and correct

copies of the originals, and if such documents purport to be copies of documents filed in court, they are true and

correct copies of the originals filed with the court.

Signatures of Claimant(s)

X ____________________________________________ X ______________________________________

SUBSCRIBED AND SWORN to before me by ____________________________ on this date: _______________

X ____________________________________________

Notary Public

MY COMMISSION EXPIRES:

2. VERIFICATION BY OFFICER OR MEMBER OF A CORPORATION, PARTNERSHIP OR OTHER ENTITY

(Officer, director, shareholder, managing partner, member, etc.)

STATE OF __________________________________

} ss.

COUNTY OF ________________________________

I am the ________________________________ of the Claimant in this Application and as such am

authorized to make this affidavit on behalf of the Claimant. I have read the Application and all attachments thereto

and know the contents thereof, and I certify that the same is true of my own knowledge, except as to those matters

which are therein stated upon my information or belief, as to which matters I believe them to be true; and I further

certify that all documents attached to the Application are true and correct copies of the originals, and if such

documents purport to be copies of documents filed in court, they are true and correct copies of the originals filed

with the court.

Company Name: ______________________________________ Signature:

Title of Person

Signing: ______________________________________________ X ___________________________________

SUBSCRIBED AND SWORN to before me by ___________________________ on this date: ________________

X ____________________________________________ Notary Public

MY COMMISSION EXPIRES:

RF-107 Rev. 03/02/2018 9

3. ATTORNEY’S STATEMENT (Complete only if represented by an attorney in the filing of this Application.)

I, ____________________________________, state that I am the attorney for the claimant(s) herein. I have read,

prepared and/or assisted in the preparation of this Application, and believe the information provided to be true. I

obtained or have reviewed all documents attached to this Application and believe them to be true and correct copies

of the originals, and if such documents purport to be copies of documents filed in court, they are true and correct

copies of the originals filed with the court.

NAME OF ATTORNEY’S FIRM: _______________________________________________________________

EXECUTED on ____________________________ Signature:

at __________________________________, Arizona X _______________________________________________

Attorneys

Name:_____________________________________________

Address:___________________________________________

City, State, Zip:____________________________________________

PART V—SUMMARY

Your claim will be reviewed by the Recovery Fund Administrator. For this Application to be treated as substantially

complete, you must submit all required documentation with the completed Application, a copy of the Notice to

Judgment

Debtor (Form RF-109), and Proof of Service (Forms RF-110, 111 and 112) for each judgment debtor.

• If you supply insufficient information for the Department to determine whether the Application qualifies for

payment, the Department will mail an itemized list of deficiencies to you or your attorney within 30 days. A.R.S. §

32-2188.02(A).

•You must cure any deficiencies within 60 days or the Department will close the Application. A.R.S. § 32-2188.02.

• If the Application is complete, the Department will issue a decision within 90 days. A.R.S. § 32-2188.04.

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FORM RF-107: REAL ESTATE RECOVERY FUND APPLICATION FOR (Arizona Department of Real Estate)

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