Division use only:
Receipt # _______________
Credential # ______________
Processor initials ____________
Date__________________
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/
03/20/20 1 617
SUPERVISING COMMUNITY MANAGER
Please complete this form to obtain a designation as a Supervising Manager.
Name
Name of Business (Company name where certificate holder is conducting his/her business.
Business address (physical location, number, street, city, state, zip)
(Mailing address (if different from business address, number, street, city, state, zip)
Certificate #
ACKNOWLEDGEMENT:
Supervisor Acknowledgement
This is to verify that I, , am a duly certified Community
(Print Name)
Manager on active status with the Nevada Real Estate Division of the Department of Business
and Industry.
I hereby affirm that:
I have been actively engaged in the full-time management of a common-interest community in
the State of Nevada, another state, or the District of Columbia for at least 4 years immediately
preceding this filing;
At least 2 of the 4 years of experience are obtained in Nevada;
I am in good standing with an active certificate or permit.
By signing this affidavit, I further affirm that I will faithfully comply with all statutes and regulations
pertaining to the conduct of a Community Manager under Chapter 116 of Nevada Law.
“I declare under penalty of perjury that the foregoing is true and correct.”
Executed on........................................... .......................................................................
(date) (signature)
