Fillable To be used only by Licensees with ADRE (Arizona Department of Real Estate)

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To be used only by Licensees with ADRE (Arizona Department of Real Estate)

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ADRE Lic Form LI-202 Salesperson-Broker Change rev 08 22 2013
ARIZONA DEPARTMENT OF REAL ESTATE (ADRE)
Licensing Division
www.azre.gov
100 North 15th Avenue, Suite 201, Phoenix, Arizona 85007
'28*/$6$'8&(<
GOVERNOR
JUDY LOWE
COMMISSIONER
SALESPERSON / ASSOCIATE BROKER CHANGE (FORM LI-202)
To be used only by Licensees with ADRE Departmental Matters
Salesperson or Associate Broker Information
Licensee Name (Print):
License Number:
Expiration Date:
Email Address:
Licensee Signature
X
Date
Provisional License or Departmental Matter? Yes No
Provisional License Other Departmental Matter
Type of Change Being Made
HIRE
TRANSFER
SEVER
Licensee HIRE/TRANSFER Agent To
Hiring Entity Legal Name:
Hiring Entity DBA Name:
Physical Address (Branch):
Suite:
City:
State:
Zip Code:
County:
Phone:
Fax:
Hiring Designated Broker Name (Print):
Hiring Designated Broker Signature
X
SEVER Agent From
Severing Entity Legal Name:
Severing Designated Broker Name (Print):
Severing Designated Broker Signature
X
ADRE LICENSING USE ONLY
Effective Date
Date Stamp
Receipt
Input Date
Time Frame
TF-1
TF-2
Processed By
ADRE E&C USE ONLY
E&C SIGNATURE
DATE
ORDER
AZ
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To be used only by Licensees with ADRE (Arizona Department of Real Estate)

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Completed 20 July 2020

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