STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102
(702) 486-4033 / realest@red.nv.gov / http://red.nv.gov/
Revised 11/13/2019 Page 1 of 2 705
APPLICATION FOR RENEWAL OF THE ENERGY AUDITOR LICENSE
RENEWAL FEE: $250.00
LATE FEE: $125.00
• Renewal will be accepted by postmark up to midnight of the below expiration date. Licensees applying for renewal after
midnight of the below expiration date must remit renewal fee, late penalty reinstatement form (Form 639) and fees.
• Payment in the form of check or money order made payable to the Nevada Real Estate Division is accepted. Cash in exact
change and credit cards are accepted for in person transactions.
• Copy of current insurance must be submitted.
APPLICANT NAME (Please print):
LICENSE NUMBER: EA. EXPIRATION DATE:
CURRENT RESIDENT ADDRESS: (Information provided below will not update the business address on your license.)
Street Address
City, State, Zip Code
(Area Code) Telephone Number Email Address: (Mandatory - For Real Estate Division use only)
QUESTIONS: Please check one box.
Have you been convicted of a misdemeanor, gross misdemeanor, or felony within your renewal
period? If the answer is yes, you are required to attach a written explanation and appropriate court
documents.
YES NO
CHILD SUPPORT: Pursuant to NAC 645D.195, the following statement MUST be answered and signed. Your application
for the issuance or renewal of this license will be denied if you do not indicate on the statements which of the provisions
apply to you.
I AM NOT SUBJECT to a court order for the support of a child.
I AM SUBJECT to a court order for the support of one or more children and I am IN COMPLIANCE with that
order or a plan approved by the District Attorney or other public agency enforcing the order for the repayment of
the amount owed in that order.
I AM SUBJECT to an order for the support of one or more children and I am NOT IN COMPLIANCE with that
order or a plan approved by the District Attorney or other public agency enforcing the order for the repayment of
the amount owed in that order.
I herby certify under penalty of perjury that the answers contained in this statement are true and correct. I understand that
if I am subject to a court order for support of one or more children and I am not in compliance with that order or a plan,
my application for a license, certification or renewal of a license or certification will be denied.
I further certify that I will faithfully comply with all the statutes and regulations of the State of Nevada pertaining to the
conduct of Energy Auditors in the State of Nevada.
Signature of Applicant: Date:
