Fillable PRLS Additional Location Information (California Department of Real Estate)

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PRLS Additional Location Information (California Department of Real Estate)

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The PRLS Additional Location Information (California Department of Real Estate) form is 1 page long and contains:

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  • 12 check-boxes
  • 21 other fields

Country of origin: US
File type: PDF

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DRE USE ONLY
1. LICENSEE’S NAME (LIST AS SHOWN ON LICENSE CERTIFICATE.)
2. MAIN OFFICE ADDRESS (STREET ADDRESS, CITY, STATE, ZIP CODE)
3. MAILING ADDRESS (STREET ADDRESS OR POST OFFICE BOX, CITY, STATE, ZIP CODE)
CONTRACT APPROVED
BOND NUMBER DATE APPROVED
EFFECTIVE DATE EXPIRATION DATE
CONTRACT APPROVED
BOND NUMBER DATE APPROVED
EFFECTIVE DATE EXPIRATION DATE
CONTRACT APPROVED
BOND NUMBER DATE APPROVED
EFFECTIVE DATE EXPIRATION DATE
CONTRACT APPROVED
BOND NUMBER DATE APPROVED
EFFECTIVE DATE EXPIRATION DATE
4A. TRANSACTION TYPE 4B. BUSINESS TELEPHONE NUMBER
ADD RENEW CANCEL ( )
4C. ADDITIONAL LOCATION ADDRESS
4D. NAME OF DESIGNATED AGENT
5A. TRANSACTION TYPE 5B. BUSINESS TELEPHONE NUMBER
ADD RENEW CANCEL ( )
5C. ADDITIONAL LOCATION ADDRESS
5D. NAME OF NEW DESIGNATED AGENT
6A. TRANSACTION TYPE 6B. BUSINESS TELEPHONE NUMBER
ADD RENEW CANCEL ( )
6C. ADDITIONAL LOCATION ADDRESS
6D. NAME OF NEW DESIGNATED AGENT
7A. TRANSACTION TYPE 7B. BUSINESS TELEPHONE NUMBER
ADD RENEW CANCEL ( )
7C. ADDITIONAL LOCATION ADDRESS
7D. NAME OF NEW DESIGNATED AGENT
LICENSEE INFORMATION
Read RE 254 and information on reverse side before completing this application.
SIGNATURE OF PRLS LICENSEE OR LICENSED OFFICER DATE
@
PRINTED NAME OF LICENSED OFFICER, IF APPLICATION IS FOR A CORPORATION.
Certication
I certify under penalty of perjury that the answers and statements given in this application are true and correct. I
understand that the Department of Real Estate cannot refund the fees submitted with this application.
ADDITIONAL LOCATION INFORMATION DRE USE ONLY
IDENTIFICATION NUMBER COPY TO CONTRACT REVIEWER DATE LICENSE SENT PROCESSOR’S NUMBER NOTES


PRLS Additional Location Information

RE 274 — Reverse
GENERAL INFORMATION
Type or print clearly in ink.








and




ADDITIONAL LOCATION(S)
 
 
          
(the
nearest intersection and the distance to it)

 

FEE AND MAILING INFORMATION
What to submit:
Cancellation of Location
 
Renewal of Location
 
 each 
 

Addition of Location
 
 each 
 
Make check or money orders payable to:

Mail To:




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PRLS Additional Location Information (California Department of Real Estate)

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Completed 28 December 2021

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