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.
LICENSE NUMBER:
DATE:
(Obtain number from NRED website or SS#)
Name of Sales Agent
First and Last name
Residence address (for division use only. Not made public)
Email address (for division use only.)
Phone number (for division use only.)
From:
First
Middle
Last
To:
First
Middle
Last
3. APPLICANT’S SIGNATURE:
4. BROKER AFFIDAVIT:
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.
X
Signature of Applicant
#
Broker or Broker Salesperson office mgr license #
(Please Print) Name of Project Broker or Broker Salesperson office manager
X
Real Estate Brokerage - Firm Name
Signature of Project Broker or Broker/Salesman Office Mgr
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 2 of 2 516
Division only: Receipt #___________________ Date: ____________________ Initials: _________________