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

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

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  • 11 check-boxes
  • 26 other fields

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


(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 OR ELECTRONIC* 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
* Electronic signature must comply with California Uniform Transactions Act (CA Civ. Code section 1633.1 et.seq.)
click to sign
signature
click to edit
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

           


           

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

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


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


       


 
 
 






  
        


  


         
        
          





      

          



          




         
        
       
       
      

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Completed 17 December 2021

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