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 03/20/2017 1 of 1 518
TIME SHARE REPRESENTATIVE CHANGE
(NRS 119A.250)
Payments to the Nevada Real Estate Division are accepted in the form of credit card, check, money order,
cashier check (made payable to the NRED) or exact change.
No. & Street City State Zip
4. Original signature of Time Share Representative: X__________________________________________________
5. AFFIDAVIT: In accordance with NRS 119A, I acknowledge that I am responsible for the inducing and soliciting
activities of the above named time share representative.
Original signature of Project Broker or authorized Office Mgr: X___________________________________________________________________________________
License number: ________________ Print name of Office Manager (if signed above):__________________________
No. & Street City State Zip
2. $25.00: PERSONAL NAME CHANGE: (Attach your original registration card and legal proof of name change. [ie:
proof may consist of copies of a marriage certificate, divorce decree, or court order.])
3. $25.00: EMPLOYER CHANGE: (Termination and original registration card must be present at the division or
accompany this form.) .....................................................................................................................................................
Name of Project Broker (Please Print)
