STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 * (702) 486-4033
e-mail: realest@red.nv.gov * http://red.nv.gov/
LOCATION OF RECORDS / TERMINATION / BUSINESS CANCELLED
REAL ESTATE BROKER FORM
Name of Broker – (Please Print)
License number:
_________________________________
For the following business, I hereby notify the Real Estate Division that my records required to be maintained pursuant to
NRS 645 will be kept in the State of Nevada for 5 years. I understand that I must give written notice to the Real Estate
Division of the exact location of these records and may not remove them until the notice of the new location has been
received by the Division. NAC 645. 655(4).
Company Name
Address location of the records.
City State Zip Code
Additional comments: (example: Records stored in a storage rental, home, another business named ???, etc.)
_____________________________________________________________________________________________________________________
X
Signature
*Home Address
*City State Zip Code
*E-mail address
*Residence or cell phone
(*required-will not be sold to third parties)
Complete below only if your license is no longer associated with the company listed above:
DISASSOCIATION date and/or resignation: ________________
Submit this form and original license within 10 calendar days of the date above. Corporate officers must attach the corporate meeting minutes stating
that the officers accepted your resignation.
You must contact the division within 10 days to make changes Forms 507 or 504, or submit Form 506 to voluntary inactivate your license.
Revised 03/20/17 512
