Fillable RE 271 (Rev. 10/20) GENERAL INFORMATION This form (California Department of Real Estate)

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RE 271 (Rev. 10/20) GENERAL INFORMATION This form (California Department of Real Estate)

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BOND APPROVAL BOND NUMBER VIOLATION PRINTS SENT
CONTRACT APPROVED DATE LICENSE SENT COPY TO PRLS CONTRACT REVIEWER
IDENTIFICATION NUMBER EFFECTIVE DATE EXPIRATION DATE PROCESSOR’S NUMBER
GENERAL INFORMATION
DRE USE ONLY
This form is to be used by individual applicants only. Corporation
applicants must use Corporation Application (RE 272).
Read page 3 before completing this application.
Type or print clearly in ink.
1. NAME OF APPLICANT (LAST, FIRST AND MIDDLE)
2. FICTITIOUS BUSINESS NAME, IF ANY (ATTACH CERTIFIED COPY OF FICTITIOUS BUSINESS NAME STATEMENT.)
3. MAILING ADDRESS (STREET ADDRESS OR POST OFFICE BOX, CITY, STATE, ZIP CODE)
4. MAIN OFFICE ADDRESS (STREET ADDRESS, CITY, STATE, ZIP CODE)
5. DO YOU RESIDE IN CALIFORNIA?
YES NO IF NO, A CONSENT TO SERVICE OF PROCESS (RE 263) MUST BE ON FILE WITH DRE.
6. BUSINESS TELEPHONE 7. RESIDENCE TELEPHONE 8. SOCIAL SECURITY OR INDIVIDUAL TAXPAYER ID NUMBER. 9. BIRTH DATE
10. HAVE YOU USED ANY OTHER NAMES (I.E., MAIDEN, AKA, ETC.)?
YES NO IF YES, LIST NAME(S) USED:
11. GENDER 12A. HAVE YOU PREVIOUSLY HELD A REAL ESTATE LICENSE IN ANY STATE, INCLUDING CALIFORNIA?
M F YES NO IF YES, COMPLETE 12B-12E.
12B. TYPE OF LICENSE 12C. EFECTIVE DATE 12D. ID NUMBER 12E. STATE
13. NAME OF DESIGNATED AGENT WHO WILL SUPERVISE MAIN OFFICE ADDRESS. CHECK ONE ID# — DRE USE ONLY
RE 256 ON FILE
RE 256 ATTACHED



RE 271 (Rev. 10/20)
BACKGROUND INFORMATION
Carefully read and provide detailed and accurate answers to questions 14-17. You must provide a "yes" or "no" response to all questions, Attach additional
sheets if you need more space. Each additional sheet must be sign by applicant. Failure to disclose pertinent information may result in denial of your
license application and/or delays.
14. 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 18.........
YES NO
15. ARE THERE ANY DISCIPLINARY ACTIONS PENDING AGAINST A BUSINESS OR PROFESSIONAL LICENSE YOU
HOLD AT THIS TIME? IF YES, COMPLETE ITEM 18.................................................................................................................. YES NO
16. 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 19............................................................................................................ YES NO
17. 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 ITEM 18 AND 19............................................................................................................................
YES NO
RE 271 Page 2 of 3
APPLICANT CERTIFICATION
I certify under penalty of perjury under the laws of the State of California that the foregoing answers and statements given in this application are true and correct,
that at the time of license issuance I will be 18 years of age or older, that if licensed I will not violate any provisions of the Real Estate Law nor abuse the privileges
of a Prepaid Rental Listing Service licensee. I understand that the Department of Real Estate cannot refund or transfer the fees submitted with this application if I
fail to qualify for the license for any reason or withdraw this application. I understand that it is my obligation to notify the Department upon licensure within 30 days
in writing or by ling form RE 238 of any conviction, criminal complaint, information or indictment charging a felony, or disciplinary action taken by another licensing
entity or authority of this state or an agency of the federal government pursuant to Business and Professions Code Section 10186.2.
20. SIGNATURE OF APPLICANT (MUST BE ORIGINAL SIGNATURE)
21. DATE
@
18. DETAILED EXPLANATION OF ITEM 14, 15, AND/OR 17. IF NEEDED, EXPLANATION MAY BE PROVIDED IN ITEM 19.
18A. TYPE OF LICENSE 18B. LICENSE ID NO. 18C. LICENSE EXPIRATION DATE 18D. STATE
18E. ACTION (revoked, etc.) 18F. DATE OF ACTION 18G. DATE ACTION TERMINATED 18H. CODE SECTION VIOLATED
19. 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.
RE 271 Page 3 of 3
READ AND RETAIN FOR FUTURE REFERENCE
General Information
• Complete all requested information on pages 1 and 2.
• Type or print clearly in ink. Penciled applications will be returned.
• This form is for individual applicants only.
• Refer to RE 254 for licensing information/requirements, and bond
and/or rider information.
• Business and mailing addresses are public information and are available
to the public. Please consider this, especially when identifying a mailing
address.
• If you electronically recreate this form to facilitate completion on a
computer, please be advised that the form should not be altered in any
manner. To do so, could result in disciplinary action. Also, please make
certain you do not delete any preprinted information and are using the
latest version of the form.
Completion Information
• Enter your legal name.
• 

license application.
Fingerprint Requirement

applicant. Fingerprints must be submitted through the California Department
of Justice (DOJ) Live Scan Program which involves the electronic taking

Completion & Submission of Live Scan Service
Request (RE 237)
Complete the Live Scan Service Request according to instructions on the
       
part of the form.

completed copy of RE 237 must be submitted with your completed original
license application and the appropriate license fee.
Fingerprint Fees


        
by the live scan provider. That fee may vary depending on the live scan
provider you choose.
Fingerprint Services (Contact the facility for fees and hours)
Many California law enforcement agencies and other private providers


site at . Please note that the hours of operation for each
provider may vary and an appointment may be required.
Out-of-State Applicants
Out-of-state residents either need to make arrangements to get their
           


Section at 877-373-4542. It should be taken to a local law enforcement
agency for completion and submitted directly to DRE with the completed

processing fee.
Fictitious Business Name


www.dre.ca.gov) to determine if the name is already in use.
License Application Fees
Refer to form RE 254 PRLS License Information for
information on fees.
Mailing Information
Submit the following documents before the license expiration date:
PRLS license application
License application fee
If appropriate, submit rider to bond, Additional Location
Application (RE 274)
Make check or money order payable to:
Department of Real Estate
Mail to: Department of Real Estate

P.O. Box 137017

 


       
individual has the right to review personal information maintained by this
Agency, unless access is exempted by law.
Department of Real Estate Assistant Commissioner
1651 Exposition Blvd. Licensing & Administration
 
General powers of the Commissioner, Sections 10050, 10071, and 10075
of the Business and Professions Code authorizes the maintenance of this
information.
Business and Professions Code Sections 30, 31(e) and 494.5(d) require
each real estate licensee to initially provide to the Department of Real
Estate his or her social security number which will be furnished to the
Franchise Tax Board. The Franchise Tax Board will use your number
        
sections also require that each application for a new license or renewal

and the Franchise Tax Board will share taxpayer information with the
Department of Real Estate, and that failure to pay tax obligations may
result in a suspension or denial of a license. The Board of Equalization
and Franchise Tax Board require the Department to collect social
        
purposes of matching the names of the 500 largest tax delinquencies
pursuant to Section 7063 or 19195 of the Revenue and Taxation Code.

shall not be deemed public records and shall not be open to the public
for inspection.
The Real Estate Law and the Regulations of the Commissioner require
         
or any part of the required information is not provided, processing may
be delayed. In addition, the Commissioner may suspend or revoke a
license, or in the case of a license applicant, may deny the issuance for
misstatements of facts (including a failure to disclose a material fact) in
an application for a license.
The information requested in this form is primarily used to furnish
license status information to the Department’s Enforcement Section, and
to answer inquiries and give information to the public on license status,
mailing and business addresses and actions taken to deny, revoke, restrict
or suspend licenses for cause.
This information may be transferred to real estate licensing agencies
        
Departments, District Attorneys, Attorney General, F.B.I.), and any
other regulatory agencies (i.e., Department of Business Oversight,
       
Bar Association).
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RE 271 (Rev. 1020) GENERAL INFORMATION This form (California Department of Real Estate)

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Completed 28 December 2021

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