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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 OPEN A FIRM (11-2014)
Page 1 of 6
Georgia Real Estate Commission
Georgia Real Estate Appraisers Board
Email: grecmail@grec.state.ga.us
LLC- attach a Certificate of Authority*
*Obtain from the Georgia Secretary of State's office
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
documentation are required, attach to the application and mail to the address above. The license is issued for (4) years. Once the completed
application, including all supporting documents, is received the license will be issued within 15 business days. An application requiring background
investigation will require additional time to process. Incomplete applications will be returned unprocessed and result in a $25.00 charge.
Include a non-refundable, license fee paid by a cashier's check or money order for $275.00 made payable to the
Georgia Real Estate Commission. This is an additional fee to the fee required for an individual Broker License.
For the Broker: Attach a Georgia Criminal Information Center report (GCIC) if you are a Georgia Resident. If you are not
a resident of Georgia, attach an equivalent report from your state of residency. This report must not be more than 60 days
old. A report from a party other than a law enforcement agency is not acceptable. Any incident listed on the report must
receive clearance. In addition, you must disclose any conviction, nolo contendere plea, or first offender sentence not
reflected on the report.
Attach supporting documentation, if required, in section B and D.
If the Broker needs to become licensed in Georgia, submit a `Real Estate Reciprocal Application' along with this
application.
Open a Firm Application
Section A
Firm Information
Company Type:
The control number for Corporations, LLC's, and Limited Partnerships is
assigned by the Georgia Secretary of State after filing with the Corporations
Division. You can locate this number on the certificate issued or on the website.
(www.sos.state.ga.us).
Secretary of State
Control Number:
Residency Status:
Firm Name:
FOR OFFICE USE ONLY
LIC#
INV
Codes
Proc By & Proc Date
Fee
Rec By
Rec Dt
Resident Firms
Corporation- attach a Certificate of Incorporation*
LLC- attach a Certificate of Organization*
Limited Partnership- attach a Certificate of Partnership*
General Partnership- attach a Partnership Agreement
Non- Resident Firms
Corporation- attach a Certificate of Authority*
General Partnership- attach a Partnership Agreement
Limited Partnership- attach a Certificate of Authority*
Reciprocal applicants do not complete section B.
Note: Firm Name for a Sole Proprietorship must include the Broker's First and Last Name OR Attach a copy of the Registered Trade Name Certification
Firm Name for a Corporation or LLC must match the Certificate of Organization or Authority OR Attach a copy of the Registered Trade Name Certification
If a franchise, both the firm name and the franchise name must appear in the registered name. The trade name must be registered in each county where the firm will
do business.
Registered Trade
Name:
PLS
PI
For the Broker: Attach a notarized Lawful Presence Verification form and a Secure and Verifiable Document, as detailed
on our website. (If not already on file with GREC)
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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 OPEN A FIRM (11-2014)
Page 2 of 6
Georgia Real Estate Commission
Georgia Real Estate Appraisers Board
Email: grecmail@grec.state.ga.us
Broker Name:
GA License Number:
YES
NO
YES
ANSWER QUESTION (1) THEN FOLLOW THE INSTRUCTIONS UNDER THE QUESTION
(1) Does the Broker need to activate an inactive Georgia License?
If Yes, PROCEED TO SECTION C If No, proceed to # 2
(2) Does the Broker currently operate any Firm(s) other than the one on this application?
If Yes, proceed to # 3
If No, proceed to # 4
NOYES
(3) Will the Broker remain the Broker of the Firm(s)?
If Yes, proceed to # 4
If No, a Change of Qualifying Broker / Firm Change Application must be submitted with this form
(4) Is the Broker currently affiliated, as an Associate Broker, with another Firm in Georgia?
If Yes, proceed to # 5
If No,
PROCEED TO SECTION C
Firm License :
Firm Name:
Print Name of Broker:
Office Phone :
Broker's Signature:
Date:
(5) Will the Broker continue to be affiliated with this Firm as an Associate Broker?
If Yes, proceed to # 6
If No, proceed to # 7
(6) You must have notified your Broker in writing, that you will be the Broker of the Firm listed on this application.
[Rule 520-1-07(4)] PROCEED TO SECTION C
(7) The Broker of the Firm where you are an Associate Broker, must release you from that Firm by
completing and signing in this section. PROCEED TO SECTION C
BROKER INFORMATION
Section B
GA Licensed Brokers Only
Mailing Address:
City:
State:
Zip Code:
County:
Alternate Phone:
Email:
YES
NO
YES NO
YES
NO
Business Phone:
Zip Code:
State:
County:
City:
Business Address:
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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 OPEN A FIRM (11-2014)
Page 3 of 6
Georgia Real Estate Commission
Georgia Real Estate Appraisers Board
Email: grecmail@grec.state.ga.us
(1) Will this applicant company and its agents receive real estate escrow / trust funds?
If YES, complete the required Escrow / Trust Account information at # 2
If NO, sign and date the waiver at # 3.
YES NO
Escrow / Trust Account
Section C
(2) ESCROW / TRUST ACCOUNT INFORMATION
(4) FIDELITY BOND OR INSURANCE COVERAGE - (Only Firms that provide Community Association Management)
(3) ESCROW / TRUST ACCOUNT WAIVER
I, the undersigned broker, do hereby certify that (1) this firm has no plans to hold trust funds in any real estate brokerage
transaction and (2) if this firm does become the custodian of any escrow / trust funds in a real estate brokerage transaction,
I shall see that the required escrow / trust account is opened within one business day of the receipt of such funds and
immediately notify the Georgia Real Estate Commission.
Account Number:
Firms that provide community association management services and collect, maintain, control, have access to, or disburse
community association funds must be covered by a fidelity bond or fidelity insurance if those funds at any time total more than
$60,000.00. That coverage must be for an amount at least equal to three months' assessments due from all members of the
association or associations managed plus any reserves that the association or associations require the broker to maintain. If
the firm currently provides such coverage, list coverage below:
Institution Name:
Bond or Policy
Number:
Date:
Brokers Signature:
Institution Name:
By law, all escrow / trust accounts must be federally insured checking accounts and used only to deposit the funds of others in
real estate brokerage transactions.
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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 OPEN A FIRM (11-2014)
Page 4 of 6
Georgia Real Estate Commission
Georgia Real Estate Appraisers Board
Email: grecmail@grec.state.ga.us
(1) Has this firm previously held a Georgia real estate license?
IF YES:
YES
NO
Firm License #:
Firm Name:
Background Information
Section D
Failure to disclose any conviction, nolo contendere plea, or first offender sentence to a criminal offense, is
grounds for denial of your license. Additional information about the Background Clearance is located on the
website at www.grec.state.ga.us.
(2)
In Georgia, or any other state, jurisdiction, or country, has the Broker or Qualifying Broker, any owner, member, officer, director or stockholder
of this Firm ever been convicted of, pled nolo contendere to, or been granted first offender treatment upon being charged with (1) a criminal offense
other than a traffic violation or (2) driving under the influence (DUI) of alcohol or drugs?
You must answer YES to this question even if:
(a) you have been pardoned for the criminal offense;
(b) anyone (lawyer, teacher, broker, government official, etc.) has told you that: (1) the offense is not, or is no longer 'on record', (2) the
offense has been expunged from your record, or (3) you do not have to disclose the offense, (4) your civil and political rights have been
restored, or (5) any similar statement that appears to suggest your 'record' has been cleared; or
(c) the conviction is not reported by the Georgia Crime Information Center (GCIC) or the National Crime Information Center (NCIC).
If YES, you must include the following documents with this application, UNLESS you have already submitted them to
this agency:
(A) For every occurrence (with the exception of a single DUI), provide a certified copy of the citation, accusation, or indictment that led
to the conviction AND a certified copy of the sentence / final disposition. If the court disposition is unavailable, provide a letter from
the court stating the documents are not available.
(B) For every occurrence (including that of a single DUI) provide a detailed written statement that includes:
1) an explanation of the circumstances surrounding every conviction
2) whether you have made any required restitution
3) whether you have completed all conditions of your sentence
4) whether you are on parole or probation (and the date it will end)
NO YES
(3) Has the Broker or Qualifying Broker, any owner, member, officer, director or stockholder of this Firm ever been disciplined by the Georgia Real
Estate Commission or the Georgia Real Estate Appraisers Board?
(4) Has the Broker or Qualifying Broker, any owner, member, officer, director or stockholder of this Firm ever been disciplined by any other state or
federal licensing agency or authority which regulates any profession? (Disciplinary actions include, but are not limited to, such actions as: a
reprimand, a suspension, a revocation, a fine, or any restriction placed on a license.)
If you answered "YES" to question (4), you must include the following documents with this application, UNLESS you have
already submitted them to this agency:
(A) For every occurrence, provide a certified copy of the final order from the licensing agency that imposed the disciplinary action.
(B) Provide a detailed written statement that includes:
1) an explanation of the circumstances surrounding the disciplinary action
2) whether you have made any required payment
3) whether you have completed all conditions of your disciplinary action
4) whether your license is currently suspended or revoked
NO
YES
NO YES
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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 OPEN A FIRM (11-2014)
Page 5 of 6
Georgia Real Estate Commission
Georgia Real Estate Appraisers Board
Email: grecmail@grec.state.ga.us
Broker's Signature
Date
(2) If the firm is a corporation, a limited liability company, or a partnership, you must supply the full name and complete residence
address for all officers, members and managers, or partners.
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.
I hereby agree that if I am or become a nonresident of the state of Georgia, I will cooperate with any investigation initiated in
accordance with the Official Code of Georgia Annotated §43-40-27 by promptly supplying any documents that any authorized
investigator of the Commission may request and by personally appearing at the Commission offices or other location in Georgia as
the Commission investigator may request.
I hereby authorize the Commission to examine any of the firm’s real estate escrow / trust accounts at such times as it may direct
and certify that I have signatory powers on all of the firm’s real estate escrow / trust accounts.
I hereby certify the information provided in this application is true to the best of my knowledge and belief.
List Names and Address ( attach additional pages if necessary)
I hereby irrevocably consent that, if any cause of action arises against me or arising from my acts or omissions as a real estate
licensee within the state of Georgia and if at the time I am not a resident of the state of Georgia, suit may be commenced against
me in the county in the state of Georgia in which said cause of action may arise, or in which the plaintiff may reside, by the service
of process upon the Real Estate Commissioner of the Georgia Real Estate Commission, whom I hereby designate for such
service; and I further consent that such service shall be begun and held in all courts to be as valid and binding as if due service had
been legally made upon me in the state of Georgia.
(1) I hereby agree that, by law, if applying for Partnership, Limited Liability Company, or Corporation, the qualifying broker is a
partner (if partnership), a member or the manager (if LLC), or an officer (if a corporation); or if applying for a sole proprietorship the
broker is the only one with an ownership interest in the firm. In addition, I agree that the qualifying broker, as required by law, is
authorized by the firm to bind it to any settlement of a contested case before the Commission as defined in Chapter 13 of Title 50,
the "Georgia Administrative Procedure," in which the firm may be named Respondent.
All Applicants must sign Part #1 below. Only applicants for a Partnership, Corporation, or Limited Liability
Company must complete Parts #2 and 3.
CertificationSection E
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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 OPEN A FIRM (11-2014)
Page 6 of 6
Georgia Real Estate Commission
Georgia Real Estate Appraisers Board
Email: grecmail@grec.state.ga.us
(3) If the firm is a partnership, a limited liability company, or a corporation, the affidavit below must be completed and signed by the
qualifying broker. The broker signature must be notarized.
(Notary Public - signature and seal must appear on form)
My Commission Expires:
, 20
, day of
Sworn and subscribed before me this
(Affiant's Signature)
(Partnership, Corporation, or LLC)
to execute said consent.
application for the license to which it is attached; and that he or she is duly authorized by said
, named in the foregoing Consent to Jurisdiction and in the
(Name of Partnership, Corporation, or LLC)
of
(Name of Affiant)
, who on oath says that he or she is a
Personally appearing before the undersigned, a notary public in and for said State and County:
County of
State of
AFFIDAVIT
(Partner, Officer, Member or Manager)
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Completed 28 December 2021

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