Fillable Form 7: (Applicant/Petitioner) (California Department of Real Estate)

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Form 7: (Applicant/Petitioner) (California Department of Real Estate)

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  • 12 other fields

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APPLICANT NAME (LAST, FIRST, & MIDDLE INITIAL)
FORMER NAME/AKA’S (LAST, FIRST)
DATE OF BIRTH (MM/DD/YYYY) GENDER HEIGHT WEIGHT
MALE FEMALE
EYE COLOR HAIR COLOR PLACE OF BIRTH
SOCIAL SECURITY NUMBER CALIFORNIA DRIVER’S LICENSE NO. AGENCY BILLING NUMBER
RESIDENCE ADDRESS (STREET/P.O. BOX, CITY, STATE, ZIP CODE)
YOUR OCA NUMBER (USE SOCIAL SECURITY NUMBER) LEVEL OF SERVICE
CALIFORNIA DEPARTMENT OF JUSTICE / FBI


 (Applicant/Petitioner)
7
PART 3 LIVE SCAN TRANSACTION
AGENCY ADDRESS SET
CALIFORNIA DEPARTMENT OF REAL ESTATE
1651 EXPOSITION BLVD, SACRAMENTO CA 95815
APPLICATION TYPE
LICENSE, CERTIFICATION, OR PERMIT
APPLICATION TITLE
REAL ESTATE LICENSE
OPERATOR NAME DATE COMPLETED TRANSMITTING AGENCY
AMOUNT COLLECTED (FOR ROLLING FEE) AMOUNT COLLECTED (FOR DOJ/FBI PROCESSING) ATI NUMBER
PART 1 CONTRIBUTING AGENCY
PART 2 APPLICANT’S PERSONAL INFORMATION
Original Copy Second Copy Third Copy
Live Scan Operator Department of Real Estate Applicant
Attention - Live Scan Service Providers

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
should be 

E-MAIL CODE
09416
CONTACT NAME
LICENSING SECTION
CONTACT TELEPHONE NUMBER
1-877-373-4542
Instructions on reverse.
Fees paid by applicant
ORIGINAL ATI NUMBER LEVEL OF SERVICE REQUESTED FOR RESUBMISSION
CALIFORNIA DEPARTMENT OF JUSTICE FBI
PART 4 LIVE SCAN RESUBMISSION TRANSACTION
AGENCY ORI NUMBER
A0075
I have received and read the included Privacy Notice, Privacy Act Statement, and Applicant's Privacy Rights.
Applicant Signature Date
RE 237 Page 2 of 4
APPLICANT INSTRUCTIONS
Fingerprint Requirement

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         
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          
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

Completion of Form RE 237 Live Scan Service
Request

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 
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



Submission of Fingerprint Form





         

Fees
Processing fee     
        

Service fee



Fingerprint Services (Contact the facility for fees &
hours.)
      
     


   


RE 237 Page 3 of 4


                  
                 
                
            
             
               
                      
                     
                      
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Completed 13 July 2021

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