Rev. 8/19/2013 Page 2 of 2
160 East 300 South, PO Box 146711, Salt Lake City, UT 84114-6711
Telephone (801) 530-6747 • Facsimile (801) 526-4387 • Internet: www.realestate.utah.gov • Email: realestate@utah.gov
State of Utah
Department of
Commerce
UTAH DIVISION OF REAL ESTATE
PRE-LICENSE SCHOOL RENEWAL
YES NO
5. Since your last renewal, have you allowed a professional or occupational
credential (license, registration, certification, or similar authorization to work in a
professional or occupational capacity) to expire or lapse while you were under
investigation by a regulatory or licensing body, or while a regulatory action was pending
against you?
6. Do you have knowledge of any complaint, investigation, or disciplinary action
CURRENTLY ongoing or pending against you by a regulatory or licensing body?
7. Since your last renewal, have you been convicted of, or pled guilty or nolo
contendere to a felony, class A misdemeanor, class B misdemeanor, or comparable
criminal offense? A traffic offense can be prosecuted as a felony, class A misdemeanor,
class B misdemeanor, or comparable criminal offense? Where this is the case disclosure
is required.
8. Since your last renewal, have you resolved a felony, class A misdemeanor, class
B misdemeanor, or comparable criminal offense through a plea in abeyance, diversion
agreement, withheld judgment, or other method whereby a charge was held in suspense
during a period of time in which you were on probation or were obligated to comply with
conditions outlined by a court? A traffic offense can be prosecuted as a felony, class A
misdemeanor, class B misdemeanor, or comparable criminal offense, Where this is the
case disclosure is required.
9. Currently, are you aware of any investigation(s), indictment(s), or criminal
charge(s) for any crime in any jurisdiction which are pending against you?
10. Since your last renewal, have you been courts martial or discharged other than
honorably from any branch of the armed services?
11. Since your last renewal, have you been required to register as a sex offender?
12. Since your last renewal, have you had a judgment entered against you in a civil
court or in a bankruptcy court on the basis of fraud, misrepresentation, or deceit, or in any
matter related to purchase, sale, management, finance, loan origination, or valuation of
real estate?
13.
Since your last renewal, have you been found in contempt of court?
YES answers require a detailed letter of explanation and copies of all court documents including charging
and judgment documents, court dockets, and proof of completion of probation and restitution orders and
payment of fines and judgments.
I hereby certify that I have read each disclosure question stated above, that I understand each question, and that I
have answered the questions truthfully and accurately, I agree to be bound by the answers I have provided, and I
understand that I may be sanctioned if any of my answers are found to be misleading or incorrect.
Signature ___________________________________________ Date __________________
