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 2 516
TIME SHARE SALES AGENT LICENSE CHANGE
(NRS 119A.220)
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.
(Obtain number from NRED website or SS#)
Residence address (for division use only. Not made public)
Email address (for division use only.)
Phone number (for division use only.)
1. $25.00 - PERSONAL NAME CHANGE: Attach your original license and legal proof of name change. [ie: proof may
consist of copies of a marriage certificate, divorce decree, or court order.]
2. $25.00 - EMPLOYER CHANGE: Termination and original license must be present at the division or accompany this
form)
Project name :_______________________________________________________________________________________________
Name of Developer:__________________________________________________________________________________________
Location Address: ___________________________________________________________________________________________
No & Street City State Postal code
3. APPLICANT’S SIGNATURE:
In accordance with NRS 119A, I acknowledge that I am
responsible for the Timeshare sales, inducing, and
soliciting activities of the above named time share Agent
as long as they are employed by me. I declare that within
10 days, I will notify the Nevada Real Estate Division of
any change in association or location.
Broker or Broker Salesperson office mgr license #
(Please Print) Name of Project Broker or Broker Salesperson office manager
Real Estate Brokerage - Firm Name
Signature of Project Broker or Broker/Salesman Office Mgr