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 IREQUIRED 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)
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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).
________________________________________________________________________________________________________
________________________________________________________________________________________________________
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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.
_____________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
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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:
________________________________________________________________________________________________________
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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
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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:
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_____________________________________________________________________________________________
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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. _____________________________________________________________________
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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 IIDOCUMENTATION
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
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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.
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PART IVSIGNATURE 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:
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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 VSUMMARY
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.