Fillable (For Broker Licensees) Read instructions on page 2 (California Department of Real Estate)

Fill Online, Printable, Fillable, Blank (For Broker Licensees) Read instructions on page 2 (California Department of Real Estate) Form

Use Fill to complete blank online CALIFORNIA DEPARTMENT OF REAL ESTATE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

(For Broker Licensees) Read instructions on page 2 (California Department of Real Estate)

On average this form takes 8 minutes to complete

The (For Broker Licensees) Read instructions on page 2 (California Department of Real Estate) form is 1 page long and contains:

  • 0 signatures
  • 11 check-boxes
  • 26 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your California Department of Real Estate forms online.

BROWSE CALIFORNIA DEPARTMENT OF REAL ESTATE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 



(For Broker Licensees)

          
     


Read instructions on page 2 before completing.
Note:       
eLicensing.)
TYPE OF CHANGE
[Check appropriate box(es)]
Mailing Address*
Main Oce Address*
Telephone/Email Address*
Personal Name
Add/Cancel Fictitious
Business Name
BROKER INFORMATION
1. LICENSE IDENTIFICATION NUMBER DRE USE ONLY
2. BROKER NAME (LAST) (FIRST) (MIDDLE) (SUFFIX)
3. BROKER NEW PERSONAL NAME (LAST) (FIRST) (MIDDLE) (SUFFIX)
DRE USE ONLY
4. DO YOU RESIDE IN CALIFORNIA?..............................................................................................................................................................................
IF NO, FORM RE 234 MAY BE REQUIRED. SEE PAGE 2.
YES NO
5*. BROKER MAILING ADDRESS (STREET ADDRESS OR POST OFFICE BOX)
CITY STATE ZIP CODE
DRE USE ONLY
6*. BROKER MAIN OFFICE ADDRESS (STREET ADDRESS) — ENTER MAIN ADDRESS OR “NO BUSINESS ADDRESS"; DO NOT LEAVE BLANK.
CITY STATE
CA
ZIP CODE
DRE USE ONLY
7
*. CURRENT TELEPHONE NUMBER (required)
( )
8*. CURRENT EMAIL ADDRESS (required)
9
*. BUSINESS CELL PHONE NUMBER
( )
10*. BUSINESS TELEPHONE NUMBER
( )
11A. FICTITIOUS BUSINESS NAME (DBA) — PRINT AS IT APPEARS ON FILING FROM COUNTY CLERK.
ADD OR
CANCEL
• Refer to page 2.
• Enter one name per line.
• Check “add” or “cancel” box.
• Attach FBNS.
• Broker-Associates — Do not
list your responsible broker or
your responsible broker's DBA.
11B. ADDITIONAL FICTITIOUS BUSINESS NAME, IF ANY
ADD OR
CANCEL
12. ORIGINAL SIGNATURE OF BROKER (IF NAME CHANGE HAS OCCURRED, USE NEW LEGAL NAME.)
@
DATE
DRE USE ONLY
PROC. # COMMENTS
DATE PROCESSED
DRE USE ONLY
DRE RECEIVED DATE
DRE USE ONLY
RE 204 Page 2 of 2
Instructions
          all

Change of Personal Name


new


Mailing Address      

Non-California Residents
notarized


Main Oce Address
must




Fictitious Business Namenot

add




 

www.dre.ca.gov

           


           

 
cancelcancel

Mailing Information


Mail To:



Try eLicensing
eLicensing 
 eLicensing
www.dre.ca.gov:
 
       

 
 
 
 
 
 
General Information










Broker-Associate



broker-associates

broker-associate



broker-associate

broker-associate



 (or ctitious name)       broker-associate
broker-associate
           
broker-associate
 broker-associate       

      Remember — a broker is
always a broker regardless of any working relationship that may exist
with another broker.
INSTRUCTIONS


       


 
 
 






  
        


  


         
        
          





      

          



          




         
        
       
       
      

Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

(For Broker Licensees) Read instructions on page 2 (California Department of Real Estate)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 6 August 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document