For Division use only: Date request received: ______________________ Received by: ___________
Date request completed: ____________________ Completed by: ___________
Rev. 05/15/2017 638
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/
REQUEST FOR RECORD OF COMPLAINTS
Requestor Information:
Name: _____________________________________________________________________________________
Address: _____________________________________________________________________________________
_____________________________________________________________________________________
Phone No. ________________________________ E-Mail: ________________________________________
Fax No. _________________________________ Other: ________________________________________
Reason for request: ______________________________________________________________________
Requestor License No
. (If applicable): _____________________________________________________________
Subject of Request:
Name: _______________________________________________ License No. ____________________
(Real estate licensee, property manager, appraiser, business broker, home inspector, asset manager)
Name of Company: _______________________________________________________________________
Please submit one form per licensee.
The information provided will not go beyond the scope of NRS 645.620 or NRS 645C.220(1). If you require
information beyond that scope, you may be required to obtain a court order pursuant to NRS 645.180(2) and
645C.220(2).
The Division may take up to five (5) working days to complete this request. If you have not received a response
within five days, please contact the Administration Section at 702-486-4036.
I have read and understand the foregoing information regarding my request.
________________________________________________ Date: ___________________________
Signature of Requestor
