Fillable REAL ESTATE DIVISION DUAL LICENSE APPLICATION (Nevada Real Estate Division)

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REAL ESTATE DIVISION DUAL LICENSE APPLICATION (Nevada Real Estate Division)

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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 2/25/2020 Page 1 of 3 Form 533
DUAL LICENSE APPLICATION
FOR A LICENSED NEVADA BROKER
FEE: $145.00 – REQUIRED. Fee includes a $40.00 fee for the Education Research and Recovery Fund.
DOCUMENTS REQUIRED:
CORPORATE, PARTNERSHIP OR LLC BROKER: Submit a current registered list of officers, managers, or a
partnership agreement. Broker must be named as an officer in the CORP, be named as a partner in a partnership,
or be named as a manager of an LLC.
INDIVIDUAL BROKER: If applicable, submit a copy of the Fictitious name filed with the county clerk. Submit a
written letter signed by an Officer of the Corporation, Partner of Partnership, or Manager of the LLC
acknowledging the awareness of licensee acting as Individual Broker.
Attach a completed Location of Records Form 512.
1. PERSONAL INFORMATION:
CURRENT LICENSE NUMBER:
First Name: Last Name: Middle Initial:
Home Address:
City: State: Zip Code:
Phone Number: Email Address:
2. BUSINESS INFORMATION:
Attach proof of the Company registration with the County and or Secretary of State in Nevada. Include the registered
officer, manager, partner, or ownership status. License type applying for (please check one box):
Domestic Corporation Limited Liability Company Partnership Individual
Firm Name:
Firm Address:
City: State: Zip Code:
Firm Mailing Address:
City: State: Zip Code:
Phone Number: Fax Number: *Email Address:
*For the Nevada Real Estate Division’s records only. Personal addresses and emails are not sold or provided publicly.
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 2/25/2020 Page 2 of 3 Form 533
3. STATEMENT OF CHILD SUPPORT
Pursuant to NRS 645.358, the following statement must be answered and signed. Your application for the renewal of
this license will be denied if you do not indicate on the statement which of the provisions that is applicable to you.
Check ONE box only.
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 AM IN COMPLIANCE with that order or
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 a court order for the support of one or more children and NOT IN COMPLIANCE with that order
or plan approved by the district attorney or other public agency enforcing the order for the repayment of the amount
owed in that order.
4. CRIMINAL HISTORY QUESTION
Have you been convicted of a misdemeanor, gross misdemeanor, or felony in the past 7 years? (If
you answered yes, attach a written explanation and appropriate court documents).
Yes No
5. APPLICANT’S DECLARATION AND SIGNATURE
❖ I hereby certify under penalty of perjury that the answers contained in this application 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 plan, my application for 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 real estate licensees in the State of Nevada.
Applicant Signature: Date:
DIVISION USE ONLY:
Receipt Number: Staff Initials: New License: B.
DATA ENTRY INFORMATION
Date of last broker exam: SSN: Date of Birth:
Date last fingerprinted: Date fingerprints received: FBI STATE
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 2/25/2020 Page 3 of 3 Form 533
REPORT OF EXISTENCE OF NEVADA BUSINESS LICENSE
Pursuant to NRS 645
All applicants MUST complete this section. Please select ONE option.
I have a Nevada business license number assigned by the Nevada Secretary of State upon compliance with the
provisions of NRS Chapter 76.
My Nevada business license number is:
I have applied for a Nevada business license with the Nevada Secretary of State upon compliance with the
provision of NRS Chapter 76 and my application is pending.
I do NOT have a Nevada business license number.
The Real Estate Division is not the arbiter of determining whether the applicant needs a business license. Information
about the Nevada business license can be found on the Secretary of State’s website at: http://nvsos.gov
ARE YOU A VETERAN? YES NO
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Completed 28 December 2021

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