612 South Summit Street Little Rock, AR 72201 501.683.8010
The following information is furnished to the Arkansas Real Estate Commission as required by Arkansas
Code Ann. §18-14-203(c)(3) and Commission Regulation 13.1(c)(4) for recertification of the registration
of the Time-Share Plan named below. ATTACH ADDITIONAL SHEETS IF NECESSARY.
1. TIME-SHARE PLAN
I. Name: __________________________________________________________________
II. Location: _______________________________________________________________
III. Address of Project: ________________________________________________________
Street and P.O. Box
________________________________________________________________________
City State Zip Code
2. ON-SITE INDIVIDUAL FOR CONTACT PURPOSES
I. Name & Title: ___________________________________________________________
II. Telephone No.: ___________________________________________________________
III. Email Address:___________________________________________________________
IV. Mailing Address: _________________________________________________________
Street and/or PO Box
________________________________________________________________________
City State Zip Code
3. DEVELOPER’S COMPANY/CORPORATION
I. Name: __________________________________________________________________
II. Location: _______________________________________________________________
III. Name & Title of individual for contact purposes:
________________________________________________________________________
IV. Telephone No.: ___________________________________________________________
Print Form
612 South Summit Street Little Rock, AR 72201 501.683.8010
V. Email Address:___________________________________________________________
VI. Mailing Address: _________________________________________________________
Street and P.O. Box
________________________________________________________________________
City State Zip Code
4. In what state is your Time-Share Plan fully registered? __________________________________
5. Attach a current copy of the Public Offering Statement provided to Purchasers, pursuant to
Arkansas Code Ann. §18-14-404.
Attach a current registration approval from the state where the Time-Share Plan is fully
registered.
6. Is there any other information which is necessary to reflect a material change from the previous
registration?
YES NO
If yes, please attach information along with an explanation.
7. RECERTIFICATION FEE: ($300.00) Amount enclosed $__________________
IMPORTANT: This Abbreviated Registration may not cover multiple Time-Share Plans. For each
Time-Share Plan Fully registered a separate Abbreviated Registration is required.
Submitted By (Name and Title):
______________________________________________________________________________
_______________________________________________________Date___________________
Signature
NOTE: Please return the completed form with filing fee to the Arkansas Real Estate Commission
by June 1
st
. Thank you for your cooperation.