Fillable GENERAL INFORMATION Read Sections III and IV before (California Department of Real Estate)

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GENERAL INFORMATION Read Sections III and IV before (California Department of Real Estate)

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
 

 

Read Sections III and IV before completing this application.

broker-ocer applicant.
         
must
        


DRE RECEIVED DATE
GENERAL INFORMATION
SECTION I — CORPORATION INFORMATION
1A. DOES THIS CORPORATION CURRENTLY HOLD OR HAS IT PREVIOUSLY HELD A REAL ESTATE LICENSE IN CALIFORNIA?
YES IF YES, COMPLETE ITEMS 1B - 4D. NO IF NO, COMPLETE ITEMS 2A - 4D
DRE USE ONLY
1B. DRE CORPORATION LICENSE NUMBER 1C. EXPIRATION DATE
2A. CORPORATION NAME (PRINT NAME AS IT APPEARS ON CERTIFICATE OF STATUS, DO NOT LIST FICTITIOUS BUSINESS NAMES.)
2B. CALIFORNIA SECRETARY OF STATE IDENTIFICATION NUMBER (REFER TO PAGE 5) 2C. FEDERAL TAXPAYER IDENTIFICATION NUMBER
(REQUIRED - SEE PRIVACY NOTICE)
3A. MAILING ADDRESS (STREET ADDRESS OR POST OFFICE BOX)
3B. CITY 3C. STATE 3D. ZIP CODE
4A. MAIN OFFICE ADDRESS (STREET ADDRESS - MUST BE A PHYSICAL ADDRESS)
4B. CITY 4C. STATE
CA
4D. ZIP CODE
5. FICTITIOUS BUSINESS NAME (IF ANY) – ATTACH A COPY OF THE FICTITIOUS BUSINESS NAME STATEMENT AS FILED WITH THE COUNTY CLERK.
SECTION II — BROKER-OFFICER INFORMATION
6A. DO YOU CURRENTLY HOLD OR HAVE YOU PREVIOUSLY HELD A REAL ESTATE LICENSE IN CALIFORNIA?
YES IF YES, COMPLETE ITEMS 6B - 11. NO IF NO, COMPLETE ITEMS 7 - 11
6B. LICENSE IDENTIFICATION NUMBER 6C. TYPE OF LICENSE 6D. EXPIRATION DATE OF LICENSE
7. NAME OF BROKER-OFFICER (LAST, FIRST & MIDDLE)
8. SOCIAL SECURITY NUMBER OR INDIVIDUAL TAXPAYER ID NUMBER
(REQUIRED-SEE PRIVACY NOTICE)
9. BIRTH DATE (MM/DD/YYYY) 10. CORPORATE OFFICER TITLE
11. TYPE OF BROKER-OFFICER LICENSE REQUESTED: (CHECK ONE) REFER TO FEE SECTION ON PAGE 6.
 DESIGNATED BROKER-OFFICER
 ADDITIONAL BROKER-OFFICER (Refer to Fees.)
 SUBSTITUTION OF CURRENT DESIGNATED BROKER-OFFICER (Refer to page 5, Section II Instructions, #11.)
DRE USE ONLY
RESTRICTED LICENSE
 CORPORATION
 OFFICER
FINGERPRINTS
 RECEIVED
 NOT NEEDED
FLAG CLEARANCE VIOLATIONS
CLEARANCE REC'D

DOJ
 FBI
RAP REC'D
 DOJ
 FBI
NOTES
EXAM ID NUMBER PROCESSOR # & DATE PROCESSED LICENSE EFFECTIVE DATE LICENSE EXPIRATION DATE




DRE USE ONLY
DRE USE ONLY
RE 201 Page 2 of 6
BACKGROUND INFORMATION
Carefully read and provide detailed answers to questions 21-24. You must provide a "yes" or "no" response to all questions, and completely and accurately provide
the detailed information required. Attach additional sheets if you need more space. Each additional sheet must be signed by the applicant. Failure to disclose
pertinent information may result in denial of your license application and/or delays.
21. HAVE YOU EVER HAD A DENIED, SUSPENDED, RESTRICTED OR REVOKED BUSINESS OR
PROFESSIONAL LICENSE (INCLUDING REAL ESTATE), IN CALIFORNIA OR ANY OTHER STATE?
IF YES, COMPLETE ITEM 25......................................................................................................................... YES NO
22. ARE THERE ANY LICENSE DISCIPLINARY ACTIONS PENDING AGAINST A BUSINESS OR
PROFESSIONAL LICENSE YOU HOLD AT THIS TIME? IF YES, COMPLETE ITEM 25.......................... YES NO
23. HAVE YOU EVER BEEN REQUIRED TO REGISTER AS A SEX OFFENDER PURSUANT TO THE
PROVISIONS OF SECTION 290 OF THE CALIFORNIA PENAL CODE OR ANY COMPARABLE LAW OF
ANY STATE OR GOVERNMENTAL UNIT? IF YES, COMPLETE ITEM 26.................................................. YES NO
24. HAVE YOU EVER BEEN ORDERED TO CEASE, DESIST AND/OR REFRAIN FROM DOING AN
ACT(S),OR FROM VIOLATING A LAW, RULE OR REGULATION BY, OR CITED FOR A BREACH
OF ETHICS OR UNPROFESSIONAL CONDUCT, BY AN ADMINISTRATIVE AGENCY OR
PROFESSIONAL ASSOCIATION IN CALIFORNIA OR ANY OTHER STATE? IF YES, COMPLETE
ITEMS 25-26....................................................................................................................................................... YES NO
25. DETAILED EXPLANATION OF ITEM 21, 22 AND/OR 24. IF NEEDED, EXPLANATION MAY BE PROVIDED BELOW.
25A. TYPE OF LICENSE 25B. LICENSE ID NO. 25C. LICENSE EXPIRATION DATE 25D. STATE
25E. ACTION (revoked, etc.) 25F. DATE OF ACTION 25G. DATE ACTION TERMINATED 25H. CODE SECTION VIOLATED
26. ADDITIONAL INFORMATION: SPECIFY WHICH LINES YOU ARE REFERRING TO. ATTACH EXTRA SHEETS IF MORE ROOM IS NEEDED. EACH
ADDITIONAL SHEET MUST BE SIGNED BY APPLICANT.
BROKER-OFFICER INFORMATION (CONTINUED)
12. DO YOU RESIDE IN THE STATE OF CALIFORNIA?
YES NO IF NO, THEN A CONSENT TO SERVICE OF PROCESS (RE 234) MUST ALSO BE COMPLETED. (Refer to #12 instruction on page 5.)
13. ARE YOU CURRENTLY SERVING IN THE U.S. MILITARY?
YES NO
14A. HAVE YOU PREVIOUSLY SERVED IN THE U.S. MILITARY? 14B. IF YES, WERE YOU HONORABLY DISCHARGED?
YES NO YES NO (See page 6 for expedited processing instructions)
15. CURRENT PHONE NUMBER (REQUIRED)
( )
16. CURRENT EMAIL ADDRESS (REQUIRED - PRINT CLEARLY)
17. BUSINESS TELEPHONE NUMBER
( )
18. BUSINESS CELL PHONE NUMBER
( )
19. HAVE YOU EVER USED ANY OTHER NAMES (i.e., MAIDEN NAME, AKA, ETC.)?
20. GENDER
YES IF YES, LIST NAMES USED: _____________________________________________________ NO MALE FEMALE
RE 201 Page 3 of 6
Note: Broker-Ocer Applicant should review pages 1 and 2 of this document prior to proceeding.
OFFICER CERTIFICATION
          



cannot refund the
fees
                   











27. SIGNATURE OF BROKER-OFFICER APPLICANT (MUST BE ORIGINAL SIGNATURE)
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28. DATE
29. TYPED NAME OF SIGNER
RE 201 Page 4 of 6
CERTIFICATION




A completed Corporation Background Statement(s) (RE 212) is attached 

30. CORPORATION NAME
31. SIGNATURE OF BROKER-OFFICER APPLICANT (MUST BE ORIGINAL SIGNATURE)
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32. DATE
SECTION III — REGULATION 2746
Corporate Real Estate Brokers, Ocers, Directors and Shareholders
 



 

 

 

 

 


 


 
RE 201 Page 5 of 6
GENERAL INFORMATION
 

       Penciled applications will be
returned.
Filing Period       







   
          

        
 




Corporation Background Statement (RE 212)





IF


In all instances

        

Continuing Education –    
         


Instructions to License Applicants

COMPLETION INSTRUCTIONS FOR SECTION I
Note:      



1A        

 Corporation Name & ID      




and

 




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 
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Fictitious Business Name       
 
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
 

site at www.dre.ca.gov

 

 

COMPLETION INSTRUCTIONS FOR SECTION II
A 



Social Security Number

Birth Date
 
      
         

11      — Check the



      

 California Residence
Non-California Residents
notarized

Military Service — Mark the appropriate answers to these



  —

 
        


 

SECTION IV — READ AND RETAIN FOR FUTURE REFERENCE

RE 201 Page 6 of 6
COMPLETION INSTRUCTIONS FOR SECTION III
 Regulation 2746

• Note — At least one box

FINGERPRINT INFORMATION
Completion & Submission of RE 237


  

www.dre.ca.gov.
          


  
 


Fingerprint Services (Contact the facility for fees/hours)
       

         
 www.ag.ca.gov 
           
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


877-373-4542

  

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








       


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



RE 866 Filing Requirements



       



FEES AND MAILING INFORMATION
Fees


Do not send cash.
 
Department of Real Estate
 

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       
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 
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 
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
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  
        
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
  
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
         
        
          
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

    
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          



          




         
        
       
       
       

GENERAL INFORMATION




 
 
 
 

 
 
 




LICENSING A CORPORATION
AS A REAL ESTATE BROKER
        


Refer to:       
          






Note: 
separate entities 



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

 Corporation License Application    


• Corporation Background Statement    





       
only





• Certicate of Status — 
 










• Fictitious Business Name (DBA) — 
          

     


• Branch Oce — 

• Salespersons — 

GENERAL INFORMATION
NEW & CURRENTLY LICENSED CORPORATIONS
Assignment of Supervisory Responsibility —  


       

Do not

RECORD CHANGES
AFTER THE CORPORATION HAS BEEN LICENSED


   
    if     






Corporate License Instructions

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RE 218
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To Change a Main Oce Address or Mailing Address

To Add or Delete a Fictitious Business Name (DBA)

Note:          


Change of Corporation Name
         


      
         

Reactivating an Expired Corporation
         



How to Cancel a Corporation

all


         

Cancelling An Additional Ocer


          

Re-Activating A Cancelled Corporation

       
           
new
eLicensing
       
eLicensingwww.dre.ca.gov
 
 

 
 
 
 
 
 
Broker-Ocer Changes
• Substitution of designated broker-ocer with a new ocer
        


and


or
     


       

         
       





Note:

• Adding “additional” broker-ocers   


          

• Adding a new ocer to be the designated broker-ocer and
the current designated ocer is remaining as an “additional”
broker-ocer       
 



        


            



Note:




• Change of designated broker-ocer with another currently
licensed broker-ocer      



Note:


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FEES AND MAILING INFORMATION
Fees — 

Acceptable payment methods
Do not send cash.
 
Department of Real Estate
 

Mail To: 


EXPEDITED PROCESSING FOR U.S. VETERANS


 
         

     

 


Mail To — 



PRIVACY INFORMATION:

       


 
 
 






   
        


  


         
        
          





     

          



          




         
        
       
       
       

GENERAL INFORMATION
The Department of Real Estate is required to collect demographic information regarding applicants for licensure pursuant to Business
& Professions Code 480 et seq., if the applicant chooses to provide this information. Providing this information is voluntary, and
providing responses will not impact the Department’s review of your license application.
GENDER:
ETHNIC IDENTITY:
ASIAN PACIFIC ISLANDER
BLACK OR AFRICAN AMERICAN
AMERICAN INDIAN OR ALASKA NATIVE
HISPANIC OR LATINO (ALONE OR IN
COMBINATION WITH ANY OTHER RACE)
WHITE
MULTIPLE RACES*
I CHOOSE NOT TO IDENTIFY
MULTIPLE ASIAN**
INDIAN
CAMBODIAN
CHINESE
FILIPINO
JAPANESE
KOREAN
LAOTIAN
VIETNAMESE
OTHER ASIAN
MULTIPLE PACIFIC ISLANDER***
GUAMANIAN
HAWAIIAN
SAMOAN
OTHER PACIFIC ISLANDER
* If you identify with more than one race that is Non-Hispanic or Latino, select Multiple Races.
** If you identify with more than one Asian ethnicity, select Multiple Asian
*** If you identify with more than one Pacic Islander ethnicity, select Multiple Pacic Islander
State of California
Department of Real Estate
License Application Demographic Survey
RE 243 (Rev. 7/20)
Male Female Non-binary
Thank You For Completing This Questionnaire
I choose not to identify
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GENERAL INFORMATION Read Sections III and IV before (California Department of Real Estate)

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Completed 13 July 2021

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