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 12/18/2019 Page 4 of 6 Form 537
4. Investigation Information:
If your answer is YES to any of the following questions, attach the order of the court as a result of the proceedings.
On an attached sheet, write full details, including the administrative agency, court, title of the proceeding, disposition,
and any other pertinent information.
a. Have you or any business in which you are or were an owner, partner, officer or director ever been
involved in an administrative proceeding regarding any professional or occupational license?
Yes No
b. Has any license issued to you or any partnership or corporation of which you were a member or officer
by any public authority been suspended or revoked?
Yes No
c. Has a surety company declined to be surety on any bond written on you in the two years prior to the
date of the application?
Yes No
d. Have you ever been convicted of a felony, gross misdemeanor, or misdemeanor? Yes No
e. Have you ever been convicted of, or are you under indictment for, or have you entered a plea of guilty
or nolo contendre to forgery, embezzlement, obtaining money under false pretenses, larceny, extortion,
conspiracy to defraud or any crime involving moral turpitude?
Yes No
f. Are you presently on parole or probation or paying any restitution? Yes No
g. Have you ever filed bankruptcy or has bankruptcy been filed against you? If filed within 7 years from
the date of this application, please provide a copy of the discharge. Date of discharge:
Yes No
5. CHILD SUPPORT DECLARATION FOR NRS 425.520
Please indicate in the appropriate box below which one of the provisions apply to you. Your application for the
issuance of this license will be denied if you do not complete this section.
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.
6. DECLARATION: Signature of Applicant (NRS 53.045)
I, (print name) , hereby, under penalty of perjury, declare that the answers contained in
this application are true and correct; and I understand:
• That if I am subject to a court order for the support of one or more children and am not in compliance with that
order or plan, my application for license, certification or renewal of a license or certification will be denied;
• 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;
• That by signing this application I authorize any person or institution to which reference is made by me in
connection with the application to release or divulge to the Real Estate Division any information in the possession
of such person or institution regarding me.
Signature of Applicant: Date: