Fillable Form is completed by licensees to request a (Arizona Department of Real Estate)

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ADRE Lic Form LI-218 Lic Cancel rev 07.31.2013
Page 1 of 1
ARIZONA
DEPARTMENT OF REAL ESTATE (ADRE)
Licensing Division
www.azre.gov
100 North 15th Avenue, Suite 201, Phoenix, Arizona 85007
DOUGLAS A. DUCEY
GOVERNOR
JUDY
LOWE
COMMISSIONER
CANCEL LICENSE - VOLUNTARILY (FORM LI-218)
Form is completed by licensees to request a voluntary cancellation of licensure. Submit completed form and
attachments to the Department through the Department Message Center Click Here
Licensee Information
Licensee Full Name (Please Print):
Phone Number:
Email:
Active License
*
Inactive License
License Number:
Expiration Date:
Please check the boxes to affirm the information stated.
I fully understand that I have the right to voluntarily cancel my license per A.R.S. §32-2137.
I fully understand that, should I want to reinstate my license, I must comply with the requirements stated
in A.R.S. §32-2131.
I understand that I am not presently under investigation by the Department.
The Department has not commenced any disciplinary proceedings against my license.
Licensee Signature:
X
Date:
*Broker information and signature only required for active real estate licensees
Print Employing Broker Name:
X
Date:
ADRE will handle inactivation process
Approved (Subject to Commissioner’s Approval)
X
Judy Lowe, Commissioner
Date
FOR ADRE USE ONLY
Effective Date
Date Stamp
Receipt
Input Date
Time Frame
TF-1
TF-2
Processed By
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Form is completed by licensees to request a (Arizona Department of Real Estate)

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Completed 20 July 2020

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