Form 08-4076 - Application To Change License Status - Department Of Commerce And Economic Development - Alaska

ADVERTISEMENT

REC
STATE OF ALASKA
FOR OFFICE USE ONLY
DEPARTMENT OF COMMERCE AND ECONOMIC DEVELOPMENT
DIVISION OF OCCUPATIONAL LICENSING
REAL ESTATE COMMISSION
3601 C STREET, SUITE 722
ANCHORAGE, ALASKA 99503-5986
(907) 269-8162
E-mail: License@commerce.state.ak.us
APPLICATION TO CHANGE LICENSE STATUS
BIOGRAPHICAL INFORMATION (Please Print)
License #
NAME:
First
M.I.
Last
MAILING ADDRESS:
CITY:
STATE:
ZIP CODE:
S.S.N.:
DATE OF BIRTH:
HOME TELEPHONE NO.:
Mo
Day
Year
YES
NO
1.
Are you under indictment for, or have you ever been convicted of, forgery, theft,
extortion, conspiracy to defraud creditors, or any other felony involving moral turpitude?
(AS 08.88.171) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “
“
Have you ever had a real estate license revoked, denied, or suspended? . . . . . . . . . . . . . . . . . . . . . “
“
2.
3.
Have you ever had any other professional or occupational license revoked or suspended
in any state? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “
“
Have you ever had a fidelity bond denied or revoked? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “
“
4.
5.
Have you ever had a judgment entered against you alleging fraud, misrepresentation, or
conversion of funds? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “
“
If you answered "yes" to any of the above, attach letter explaining the nature of the action, date it occurred, resolution of
“ Explanation Attached
“ Already on File
the problem, and a copy of all supporting legal documentation.
TYPE OF ACTION REQUESTED (Check One):
“ “ Transfer License to Another Office (12 AAC 64.075)
“ “ Inactivate License (AS 08.88.251)
“ Associate Broker to Broker
“ Broker to Associate Broker
Status Change (AS 08.88.171)
Reactivate License #
(from inactive status only) (AS 08.88.251)
Reinstate License (AS 08.88.241, AS 08.01.100, and 12 AAC 64.071)
“ Lapsed for failure to renew
Payment of renewal fees and proof of continuing education must accompany application. If license has lapsed more
than two years, proof of reexamination is required.
“ Suspended for failure to associate with employing broker.
“ Suspended, pending reimbursement to Surety Fund.
Receipt for payment or copy of accepted repayment plan must accompany application.
“ Suspended for disciplinary action.
Must be approved by Commission action.
CONTINUE ON REVERSE SIDE
08-4076 (Rev. 6/98)
GO/dgl

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form 08-4251 - Application For Veterinary Technician Licensure - Department Of Community And Economic Development Form 08-4251 - Application For Veterinary Technician Licensure - Department Of Community And Economic Development Legal
Form 08-4004f - Add/change Of Mobile Intensive Care Paramedic Sponsor - Alaska Department Of Commerce And Economic Development Form 08-4004f - Add/change Of Mobile Intensive Care Paramedic Sponsor - Alaska Department Of Commerce And Economic Development Legal
Form 08-4356 - Application To Upgrade The Tonnage Of A Deputy Marine Pilot License - Department Of Commerce And Economic Development Form 08-4356 - Application To Upgrade The Tonnage Of A Deputy Marine Pilot License - Department Of Commerce And Economic Development Legal
Form 08-4172 - Procedure For Obtaining A Permit To Administer Parenteral Sedation - Alaska Department Of Commerce And Economic Development Form 08-4172 - Procedure For Obtaining A Permit To Administer Parenteral Sedation - Alaska Department Of Commerce And Economic Development Legal
Form 08-4144 - Application For Reinstatement Form - Department Of Community And Economic Development Alaska State Board Of Public Accountancy Division Of Occupational Licensing Form 08-4144 - Application For Reinstatement Form - Department Of Community And Economic Development Alaska State Board Of Public Accountancy Division Of Occupational Licensing Business
Form 08-458 - Application For Amended Certificate Of Registration - Department Of Commerce And Economic Development Form 08-458 - Application For Amended Certificate Of Registration - Department Of Commerce And Economic Development Legal
Form 08-4076a - Broker Notice To Real Estate Commission Of Licensee Termination Form - Department Of Commerce And Economic Development Form 08-4076a - Broker Notice To Real Estate Commission Of Licensee Termination Form - Department Of Commerce And Economic Development Legal
Form 08-4109f - Board Action Data Bank Inquiry Form - Department Of Community And Economic Development - Alaska Form 08-4109f - Board Action Data Bank Inquiry Form - Department Of Community And Economic Development - Alaska Legal
Form Lb-0910 - Application For Client Number - Tennessee Department Of Labor And Workforce Development Form Lb-0910 - Application For Client Number - Tennessee Department Of Labor And Workforce Development Legal
Office Registration Form - Department Of Commerce And Economic Development Division Of Occupational Licensing Office Registration Form - Department Of Commerce And Economic Development Division Of Occupational Licensing Legal

Related Categories

Parent category: Legal
Download
Go
Page of 2