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/
Revised: 03/20/17 1 of 1 656
OUT OF STATE APPLICANTS ONLY!
CONSENT TO SERVICE OF PROCESS
NON-Nevada RESIDENTS COMPLETE THIS FORM
Last
First
M.I.
Hereinafter referred to as “Applicant,” hereby irrevocably constitutes and appoints the Administrator of the
Division of Real Estate, Department of Business & Industry, State of Nevada or his/her successor in office, to
be his/her true and lawful attorney within this state, upon whom all legal process in any suit, action or
proceeding arising under, or in any way connected with any provisions of Chapter 645, 645C, 119, 119A,
119B of Nevada Revised Statutes, or any rule or order pursuant thereto, or based upon any fraud, deceit,
breach or contract or other thing connected with the sale or offer for sale, negotiation or appraisal of any real
estate, timeshare or campground membership, may be served upon said applicant, personally within the State
of Nevada. Until the applicant attests by affidavit to the Administrator that he/she is a bona fide resident of
the State of Nevada, this appointment and the authority of said attorney shall continue in force and effect so
long as any such liability remains outstanding, and a copy of any process served hereunder may be sent by
certified mail, return receipt requested, addressed to:
City
State
Zip Code
Drivers License Number
State
State of
ss. County of
This instrument was acknowledged before me in the possession of_______________________________________.
Print name of person presenting document
(Signature of person who presents the document)
Date
Signature of Notarial Officer
My Commission Expires: