Rev. 5/01/2015
INSTRUCTIONS
This change card can only be used for ACTIVATING, LEGAL NAME CHANGES, COMPANY BROKER CHANGES, OR LICENSEES ON
PROBATION NEEDING TO MAKE A STATUS CHANGE. INACTIVATING OR A CHANGE OF AFFILIATION MUST BE DONE ONLINE.
Activating from Inactive Status:
a. Submit $15 fee and required education, if any, with
change card to Division.
b. Brokers complete and submit the Company/Branch
Change form.
Changing a Broker:
c. Complete and submit change card completing both
sides.
d. Complete and submit the Company/Branch Change
form.
Legal Name Changes:
e. Complete the form and submit to the Division. No
broker’s signature is required.
f. Submit legal document authorizing the name change.
State of Utah
DEPARTMENT OF COMMERCE
DIVISION OF REAL ESTATE
160 East 300 South
Box 146711
Salt Lake City, UT 84114-6711
Fax: (801) 526-4387
Email: realestate@utah.gov
Do not use this form to inactivate or change affiliation – go to our Real Estate Online System (RELMS)
CHANGE FROM: CHANGE TO:
Name of Licensee
Sales Agent
Assoc. Broker
Branch Broker
Princ. Broker
Dual Broker
Name of Licensee
Sales Agent
Assoc. Broker
Branch Broker
Princ. Broker
Dual Broker
Licensee # Licensee #
Name of Company:
Active
Inactive
Name of Company:
Active
Inactive
Company #
Company #
Email
Email
Phone (Home) Phone (Cell)
Phone (Home) Phone (Cell)
Principal/Branch/Dual Broker License #
Principal/Branch/Dual Broker License #
Signature of Principal/Branch/Dual Broker Date
Signature of Principal/Branch/Dual Broker Date
Signature of Licensee Date
Signature of Licensee Date
DIVISION OF REAL ESTATE
CHANGE CARD
( ) Check ( ) Visa ( ) MasterCard ( ) American Express
Make checks payable to: Utah Division of Real Estate
Card # _____________________________ Expires ______________
Signature__________________________ CCV# ________________
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