Fillable Georgia Real Estate Commission Georgia Real Estate Appraisers (Georgia Real Estate Commission & Appraisers Board)

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Georgia Real Estate Commission Georgia Real Estate Appraisers (Georgia Real Estate Commission & Appraisers Board)

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229 Peachtree Street NE
Atlanta, GA 30303-1605
Phone: 404-656-3916
Fax: 404-656-6650
Suite 1000 - International Tower
GREC Change App (12-2016)
Page 1 of 3
Georgia Real Estate Commission
Georgia Real Estate Appraisers Board
Email: grecmail@grec.state.ga.us
This form can be filled out on-line. Print TWO copies: one to sign and submit for processing and one for your records. If a fee and/or
additional documentation is required, attach to the application and mail to the address above. Once the completed application,
including all supporting documents, is received the application will be processed. Incomplete applications will be returned
unprocessed and result in a $25.00 charge.
Salespersons / CAMS Complete sections A, B, C, E, and Sign in Section F of this application.
Brokers Complete sections A, B, D, E, and Sign in Section F of this application.
Section A
Individual Information
Full Name:
Real Estate Change Application
Residence
Address
State
Zip Code
City
County
Phone Number
License Number:
Change InformationSection B
E-mail
Change my Name
Print New Name:
Send a replacement wall certificate and pocket card
Licensee is deceased
Attach a copy of the obituary or death certificate.
Be sure to sign Section F of this application with this name.
Fax Number
Phone Number
Zip Code
State
County
City
Mailing
Address
Phone Number:
Address / Phone numbers can also be changed instantly by logging in at www.grec.state.ga.us.
Lic#
INV
Educ
Codes
Proc By & Proc Dt
Fee
Rec By
Rec Dt
FOR OFFICE USE ONLY
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229 Peachtree Street NE
Atlanta, GA 30303-1605
Phone: 404-656-3916
Fax: 404-656-6650
Suite 1000 - International Tower
GREC Change App (12-2016)
Page 2 of 3
Georgia Real Estate Commission
Georgia Real Estate Appraisers Board
Email: grecmail@grec.state.ga.us
4. Are you remaining active at a firm(s) while surrendering a role as Associate Broker,
or Broker, at another firm?
If Yes,
NOTE: If a firm license needs to be placed inactive or closed, submit a Close a Firm Application
If No, Proceed to # 5
Transfer my license The Broker must release you from the current firm and then your new Broker must affiliate you with a new firm.
Proceed to section E and complete parts A and B.
Activate my license The Broker must affiliate you with a firm. Proceed to section E and complete part B.
Inactivate my license The Broker must release you from the firm. Proceed to section E and complete part A
Only For Salespersons / CAMS - License Status RequestSection C
6. Are you leaving a firm where you are an Associate Broker?
If Yes, proceed to Section E and have Broker complete part A
5. Are you activating, as the Broker, back to the same firm as when your license
became inactive?
If Yes, proceed to Section E and complete part B
If No, Submit a 'Change of Qualifying Broker' or 'Open a Firm' Application INSTEAD of this form.
3. Are you transferring, as an Associate Broker from one firm to another firm?
If Yes, proceed to Section E and have Broker complete parts A & B
If No, proceed to # 4
2. Are you going to become an Associate Broker at a firm?
If Yes, proceed to Section E and have Broker complete part B
If No, proceed to # 3
INDICATE THE LICENSE STATUS YOU NEED THEN FOLLOW THE INSTRUCTIONS
DEPENDING ON THE ANSWER YOU CHOSE:
1. Indicate the status requested.
If Active, proceed to # 2
If Inactive, proceed to # 6
Only for Brokers and Associate Brokers - License Status Request
NOTE: If your license is inactive and continuing education credits are current, this application will activate
your license. Your wall license and pocket card will be mailed to your broker.
INACTIVE
ACTIVE
Section D
7. Are you leaving a firm where you are a Broker?
If Yes, proceed to Section E and complete part A
proceed to Section E and have Broker complete part A
NOTE: If the firm license is inactive , submit 'Application to Activate A Firm', to activate the firm license.
If No, Proceed to # 7
NOTE: If a firm license needs to be placed inactive or closed, submit a Close a Firm Application
YES
NO
YES
NO
YES
YES
YES
YES
NO
NO
NO
NO
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229 Peachtree Street NE
Atlanta, GA 30303-1605
Phone: 404-656-3916
Fax: 404-656-6650
Suite 1000 - International Tower
GREC Change App (12-2016)
Page 3 of 3
Georgia Real Estate Commission
Georgia Real Estate Appraisers Board
Email: grecmail@grec.state.ga.us
Firm License #
Broker Signature:
Firm Phone #
Firm Name:
A. I hereby release the above individual from this firm.
Date:
Print Broker
Name:
Firm Affiliate / Release Information
Section E
Licensee
Name:
License
Number:
I hereby affiliate the above individual to this firm and certify that the individual has entered into the written
agreement required by Substantive Regulation 520-1-.07(5).
Date:
Broker Signature:
Firm Phone #
Print Broker
Name:
Firm License #
Firm Name:
B. I hereby affiliate the above individual with this firm.
Section F
Certification
Date:
Licensee
Signature:
I hereby certify the information provided in this application is true to the best of my knowledge and belief.
If leaving a firm, I have fully complied with Substantive Regulation 520-1-.07(5).
I hereby agree not to engage in, conduct, advertise, or hold myself out as engaging in or conducting real estate brokerage activity
in Georgia until I receive my wall certificate.
I hereby authorize a representative of the Georgia Real Estate Commission to periodically obtain and receive any criminal history
record information and/or full lifetime driver history record information pertaining to me which may be in the files of any federal,
state, or local criminal justice agency.
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Georgia Real Estate Commission Georgia Real Estate Appraisers (Georgia Real Estate Commission & Appraisers Board)

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Completed 28 December 2021

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