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The following information is furnished to the Arkansas (Arkansas Real Estate Commission)

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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. §18-14-204(e) for renewal 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 and Title:
__________________________________________________________________________________
II. Telephone Number: __________________________________________________________________
III. Email Address:______________________________________________________________________
IV. Mailing Address: ____________________________________________________________________
Street and P.O. Box
__________________________________________________________________________________
City State Zip Code
3. DEVELOPER’S COMPANY/CORPORATION
I. Name: ____________________________________________________________________________
II. Location: __________________________________________________________________________
III. Name and Title of individual for contact purposes:
__________________________________________________________________________________
IV. Telephone No.: _____________________________________________________________________
V. Email Address:______________________________________________________________________
Print Form
612 South Summit Street Little Rock, AR 72201 501.683.8010
VI. Office Mailing Address:______________________________________________________________
Street and P.O. Box
__________________________________________________________________________________
City State Zip Code
4. Attach a complete copy of the Public Offering Statement currently provided to Purchasers, pursuant to
Arkansas Code Ann. §18-14-404.
5. Is the Time-Share Plan subject to any blanket encumbrances and/or liens? YES NO
If yes, please indicate below with which requirements of Arkansas Code Ann. §18-14-410 the Developer is
complying.
I. Releases of all liens affecting the Time-Share Interval. YES NO
II. A Surety Bond or Insurance against the lien from a
company acceptable to the Agency, as provided for
liens on real estate in this state. YES NO
III. An underlying lien document containing a provision
wherein the lien holder subordinates its rights to
that of a Time-Share Purchaser who fully complies
with all of the provisions and terms of the contract
of sale. YES NO
6. Attach updated and complete financial statements prepared in accordance with generally accepted accounting
principles fully and fairly disclosing the current financial condition of the Developer which are certified by a
Certified Public Accountant or a Registered Public Accountant who shall state that in his/her opinion the
financial statement presents fairly the financial position of the entity for which the certification is rendered,
pursuant to Regulation 13.8.
7. IDENTIFY THE FOLLOWING AGENTS USED, CONTROLLED OR AFFILIATED WITH THE
DEVELOPER:
I. ACQUISITION AGENT
A. Name of Company: _____________________________________________________________
B. Name and Title of Responsible Individual:
_____________________________________________________________________________
C. Office Mailing Address: _________________________________________________________
Street and P.O. Box
_____________________________________________________________________________
City State Zip Code
D. Telephone Number: ____________________________________________________________
E. Email Address:_________________________________________________________________
612 South Summit Street Little Rock, AR 72201 501.683.8010
F. Please indicate below the amount and type of Bond which has been furnished and is currently in
effect.
AMOUNT:
1) ______ A $10,000.00 Bond as required by Commission Regulation 13.1(d).
2) ______ A $50,000.00 Bond as required by Commission Regulation 13.1(d).
TYPE:
______ SURETY COMPANY BOND
______ CORPORATE BOND
______ CASH BOND
II. BROKER
A. Name of Firm: __________________________________________________________________
B. Name of Responsible Broker: ______________________________________________________
C. Office Mailing Address: ___________________________________________________________
Street and P.O. Box
_______________________________________________________________________________
City State Zip Code
D. Telephone No.: __________________________________________________________________
E. Email Address:__________________________________________________________________
F. Please indicate below the amount and type of Bond which has been furnished and is currently in
effect.
AMOUNT:
1) ______ A $10,000 Bond as required by Commission Regulation 13.1(d).
2) ______ A $50,000 Bond as required by Commission Regulation 13.1(d).
TYPE:
______ SURETY COMPANY BOND
______ CORPORATE BOND
______ CASH BOND
F. Attach a list of Brokers and Salespersons licensed with the firm.
III. MANAGING AGENT
A. Name of Firm: __________________________________________________________________
B. Name and Title of Responsible Individual:
__________________________________________________________________________________
C. Office Address:__________________________________________________________________
Street and PO Box
_______________________________________________________________________________
City State Zip Code
612 South Summit Street Little Rock, AR 72201 501.683.8010
D. Telephone No.: __________________________________________________________________
E. Email Address:__________________________________________________________________
F. Please indicate below the amount and type of Bond which has been furnished and is currently in
effect.
AMOUNT:
1) ______ A $10,000 Bond as required by Commission Regulation 13.1(d).
2) ______ A $50,000 Bond as required by Commission Regulation 13.1(d).
TYPE:
______ SURETY COMPANY BOND
______ CORPORATE BOND
______ CASH BOND
IV. EXCHANGE AGENT:
A. Name of Firm: __________________________________________________________________
B. Name and Title of Responsible Individual:
__________________________________________________________________________________
C. Office Mailing Address: ___________________________________________________________
Street and P.O. Box
_______________________________________________________________________________
City State Zip Code
D. Telephone No.: __________________________________________________________________
E. Email Address:__________________________________________________________________
8. Is there any other information which is necessary to reflect a material change from the previous
renewal registration?
YES NO
If yes, please attach information along with an explanation.
9. RENEWAL FEES:
I. Project: ($350.00) $__________________
II. Acquisition Agent ($150.00) $__________________
Broker ($75.00) $__________________
Managing Agent ($75.00) $__________________
TOTAL RENEWAL AMOUNT ENCLOSED $__________________
612 South Summit Street Little Rock, AR 72201 501.683.8010
Submitted By:
_____________________________________________________________________________________________
(Name and Title)
_________________________________________________________________Date________________________
(Signature)
NOTE: Please return completed form and fees to the Arkansas Real Estate Commission by June 1
st
.
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The following information is furnished to the Arkansas (Arkansas Real Estate Commission)

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Completed 28 December 2021

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